Thyroid : official journal of the American Thyroid Association 2017 11 28() doi 10.1089/thy.2017.0524
The number of patients who need thyroid surgery has increased worldwide in recent decades. Patients with thyroid disease experience globus pharyngeus as a result of direct compression and edema of surrounding organs. Thyroid surgery is needed to improve these symptoms or as treatment for thyroid cancer. After thyroid surgery, globus symptoms may become worse and may affect the daily life of the patient for a long time. Psychogenic problems have also been thought to cause the globus sensation. A prospective analysis of globus symptoms and psychogenic factors following thyroidectomy was performed.
MATERIAL AND METHODS
Patients scheduled to undergo thyroid surgery between February and September 2016 completed the foreign-body sensation in the throat score (FBST, range 0-8.2) and the self-rating depression scale (SDS, range 0-100) preoperatively and 3 days, 1 month, 3 months, 6 months, and 12 months postoperatively.
Long-term follow-up was completed in 616 patients (491 females, 125 males). A total of 365 patients had malignant thyroid cancer, 169 patients had benign tumors, and 82 patients had diffuse goiters with Graves’ disease. The percentage of patients who complained about neck discomfort (FBST > 2) was 29.4% before surgery. A preoperative high FBST showed a significant direct correlation with a high SDS, but thyroid volume did not. A postoperative high FBST was seen in 75.3% of patients at 2 days and 78.9% at 1 month after surgery, and it then gradually decreased to 49.3% at 12 months after surgery. At 3 days after the operation, the median FBST was significantly higher in patients who had total thyroidectomy (TT) with lateral neck dissection or TT only compared with those who had lobectomy only (all p < 0.05). These differences were still present 12 months after surgery. A higher preoperative SDS was also identified as an independent predictor for a high FBST at 12 months after surgery, but not at 1 month or 3 months postoperatively, on multivariate analyses. CONCLUSION
Preoperative globus symptoms appear directly related to psychological factors. The area of the surgical procedure and preoperative psychological factors were related to persistent neck discomfort.