H. Wong1, S. Kaplan1, M. G. White1, M. K. Applewhite2, P. Angelos1, B. Aschebrook-Kilfoy1, R. H. Grogan1 1University Of Chicago,Endocrine Surgery Research Group In The Department Of Surgery,Chicago, IL, USA 2Albany Medical College,Surgery,Albany, NY, USA
Introduction: Shoulder disability after thyroid surgery without lymph node dissection (LND) is not a commonly appreciated morbidity. Here we ask participants enrolled in the North American Thyroid Cancer Survivorship study (NATCSS) to define their shoulder disability after thyroid cancer operations and the impact of this impairment on quality of life (QoL).
Methods: NATCSS participants were asked to self-report shoulder problems. Those screening positive were provided the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, a validated instrument quantifying the severity of upper extremity disability. Responses were compared using t-test and ANOVA analyses. Known risk factors for shoulder disability such as LND were studied using univariate and multivariate logistic regression.
Results: Of 1,019 respondents, 314 (31.0%) reported shoulder disability following their operations and 161/314 (51.3%) went on to complete the QuickDASH, scoring a mean QuickDASH score of 44.9±19.9, versus 13.0±17.4 in a healthy matched population (p<0.0001). One-hundred twenty (74.5%) of those with self-reported shoulder disability had a QuickDASH score >1 SD above the population mean, while 63(39.1%) had a score >2 SD above the population mean. Those patients with shoulder disability (QuickDASH >1 SD above matched population mean) had a mean age of 58.4±8.0 and are 92.4% female. Eighty-eight (55%) patients with shoulder disability reported a history of LND. Of these, 17 (18%) reported shoulder disability on the opposite side from their LND. In other words, those 73 (45%) patients who did not report a history of LND combined with the 17 patients who reported shoulder disability on the opposite side from their LND make up 90 (56%) patients whose shoulder disability were not explained by a history of LND. On multivariate analysis, female sex (p=0.033) and history of underactive thyroid function (p=0.017) were predictive of an increased QuickDASH score (p=0.036). Increased QuickDASH scores correlated with a decrease in a number of quality of life measurements (p<0.05).
Conclusion: In this retrospective study, 56% of post-operative thyroid cancer patients reported experiencing shoulder disability that did not correlate with having a LND. Elevated QuickDASH scores in these patients quantifies the functional impairment associated with this disability. Our data also show an associated significant decrease in quality of life. While female gender, and hypothyroidism may be contributing factors, further prospective studies are required to better elucidate the reason for this phenomenon.