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BACKGROUND AND PURPOSE: Patient-reported outcomes have become important endpoints in comparative effectiveness research and in patient-centered health care. Valid patient-reported outcome measures detect and respond to clinically relevant changes. The purpose of this study was to evaluate responsiveness of the thyroid-related quality of life (QoL) instrument ThyPRO in patients undergoing relevant clinical treatments for benign thyroid diseases and to compare it with responsiveness of the generic SF-36 Health Survey.METHODS: A sample of 435 patients undergoing treatment completed the ThyPRO and SF-36 Health Survey (Version 2) at baseline and 6 months after treatment initiation. Responsiveness was evaluated in three thyroid patient groups: patients with hyperthyroidism (n = 66) and hypothyroidism (n = 84) rendered euthyroid after medical therapy, and patients with a clinically detectable nontoxic goiter treated with surgery or radioactive iodine and remaining euthyroid (n = 62). Changes in QoL were evaluated in terms of effect size and compared to the changes predicted by clinical experts. The responsiveness of equivalent scales from ThyPRO and SF-36 Health Survey were compared with the relative validity index.RESULTS: The ThyPRO demonstrated good responsiveness across the whole range of QoL aspects in patients with hyper- and hypothyroidism. Responsiveness to treatment of nontoxic goiter was also demonstrated for physical and mental symptoms and overall QoL, but not for impact on social life or cosmetic complaints, in contrast to clinicians' predictions. For all comparable scales except one, the ThyPRO was more responsive to treatment than the SF-36 Health Survey.CONCLUSIONS: The ThyPRO was responsive to treatment across the range of benign thyroid diseases. We suggest implementing this measurement instrument as a patient-reported outcome in clinical studies and in clinical management.

TODAY interest centers predominantly in the experimental studies which are adding to our knowledge of the physiology of the thyroid and the therapy of its diseases, yet practical problems still arise in the management of these conditions, especially as they are related to surgery of the gland. To the surgeon falls the lot of making important practical decisions about treatment, which are modified by the knowledge being acquired from laboratory and clinical studies. Nontoxic goiter is a very common disease. Partial thyroidectomy for this condition is one of the operations most frequently performed. It is because it is so important for a doctor to be able to determine with discrimination and accuracy those patients who should be subjected to surgery that a discussion of this matter is thought to be worthwhile. The removal of goiters which produce or threaten tracheal obstruction, or those which are large and unsightly, presents technical problems only. There is no question about the indication for surgery i...

The 24-hour thyroidal uptake of radioiodine (I131) was determined in control subjects and hyperthyroid patients before and after administration of either 500 mg. of thiourea or 4 Gm. of potassium thiocyanate. Thiourea abolished I131 uptake in 21 normal controls and in 2 patients with nontoxic goiter, whereas the mean uptake value in the hyperthyroid group (8 patients) was above 20 per cent. Potassium thiocyanate reduced the uptake values below 10 per cent in 18 euthyroid controls and 7 patients with nontoxic goiter, whereas in 15 hyperthyroid patients the values were significantly higher. The inhibitory effect of thiocyanate appeared to vary directly with the serum concentration of the ion in both the hyperthyroid and control groups. This difference in response to thiocyanate or thiourea may be a useful means to distinguish between normal subjects and patients with hyperthyroidism.

Thyroidal clearance rate measurements were made in 55 patients from 1 to 6 yr after receiving 131iodine therapy for thyrotoxicosis or nontoxic goiter. A regression of clearance rate on years after therapy was calculated for each patient. The slope of this regression line was taken as a measure of the long-term effect of therapy. The intercept of the line at zero yr (i.e., the time when the last therapy dose was administered) was used as a measure of the initial effect of therapy. The initial effect was found to correlate with estimated gram rads and millicuries retained at the first therapy dose. There was no correlation with goiter type. The longterm effect was correlated with me retained at the first dose. When this rate of fall of clearance rate was compared with the clearance rates obtained after therapy, a fall of 25% per annum was observed irrespective of thyroidal status before therapy. This was a 30-fold increase over the natural fall due to aging.

A family in which nontoxic goiter was known to occur in 5 generations is reported. Goiters which appeared in early teens were present in 4 of 5 members of the propositus's generation. Their firmness, nodularity and calcification were unique in our experience of familial goiter. Investigations failed to identify any of the recognized thyroid dyshormonogenetic abnormalities. In vivo 131I tracer studies showed a pattern of increased thyroid iodine avidity and rapid turnover. Analyses of the thyroid glands of 3 of the family showed no characteristic abnormality.

The thiocyanate suppression test, as described in the present paper, has proved to be a useful diagnostic assay in patients in whom the thyroidal radioiodine uptake or the clinical findings are equivocal. Thiocyanate, administered during 2 days by mouth at a total dose of 3 g, caused a sharp decrease in the 24-hr I131 uptake in 9 euthyroid patients and in 28 subjects with nontoxic diffuse goiter or nontoxic nodular goiter. No value exceeded 20%. In contrast, no value under 20% was obtained in 17 patients with thyrotoxicosis following thiocyanate administration.

Lymphocytes from peripheral blood of patients with various thyroid diseases and of healthy volunteers were tested for blast transformation reaction by human thyroglobulin, thyroid extract, adrenal extract, phytohemagglutinin (PHA) and staphylococcal nitrate (SF). The subjects comprised 9 patients with Hashimoto's disease, 12 hypothyroids, 8 with nontoxic goiter, 10 thyrotoxics, and 15 healthy controls. Lymphocytes from 6 of the patients with Hashimoto's disease were specifically stimulated to transform by human thyroglobulin or thyroid extract, while, among the other groups tested, only one patient with nontoxic goiter demonstrated a significant specific stimulation. It is suggested that the specific blast transformation may be caused by auto-immunization to thyroid antigens.