Time Course of Symptom Resolution and Changes in Quality of Life Following Total Thyroidectomy for Graves' Disease: A Prospective Study.

Abstract

Background: Graves' disease (GD) is associated with substantial impairment in health-related quality of life (HRQoL) owing to a broad spectrum of systemic and neuropsychiatric symptoms. Although total thyroidectomy (TT) is an effective definitive treatment, the temporal pattern of postoperative symptom resolution and recovery of HRQoL has not been well characterized. This study aimed to evaluate the time course of symptom resolution and longitudinal changes in HRQoL following TT for GD.

Methods: In this prospective observational study, 48 consecutive patients who underwent TT for GD between February 2025 and January 2026 were enrolled. All patients completed at least 6 months of postoperative follow-up. Graves' disease-related symptoms were prospectively assessed before surgery and at scheduled postoperative visits using a standardized symptom assessment form. Time to symptom resolution was analyzed using Kaplan-Meier survival analysis. HRQoL was evaluated preoperatively and at 1 and 6 months postoperatively using the 36-Item Short Form Health Survey (SF-36).

Results: The most common preoperative symptoms were irritability (72.9%), palpitations (70.8%), and heat/cold intolerance (70.8%). Kaplan-Meier analysis demonstrated that palpitations, tremor, heat/cold intolerance, diarrhea, and memory impairment resolved most rapidly, with a median time to resolution of 1 week. Anxiety, depression, ocular symptoms, pain, and irritability resolved more gradually, with a median time to resolution of 4 weeks. By the end of the 24-week follow-up, complete resolution was observed in all affected patients with palpitations, tremor, heat/cold intolerance, diarrhea, and pain. Significant improvements were observed across all SF-36 domains over time (all p < 0.005). Improvements in physical functioning, bodily pain, vitality, role limitations due to physical health, and general health were evident early after surgery and continued through 6 months, whereas social functioning improved significantly only at the sixth postoperative month.

Conclusions: TT was associated with rapid resolution of the classic manifestations of hyperthyroidism and significant, sustained improvements in both physical and psychosocial aspects of HRQoL. Defining the temporal pattern of postoperative recovery may improve patient counseling, optimize expectation management, and support shared decision-making for patients with GD.