DOES A DEDICATED ENDOCRINE SURGERY UNIT IMPACT TREATMENT DECISION IN PATIENTS WITH THYROID DISORDERS? EXPERIENCES FROM AN ENDOCRINE-SURGEON NAÏVE AREA IN SOUTHERN INDIA.

AUTHORS:
S. Manjunath (Shivamogga, India) , P.K. Devarbhavi (Shivamogga, India)
Background:
Appropriate management of thyroid diseases is crucial, as outcomes directly affect quality-of-life. High-volume thyroid surgeons provide best results,least complications. We aim to assess if a dedicated endocrine-surgery unit influences treatment-decisions(TD) of patients in an endocrine-surgeon naïve area.
Methods:
Study of 153-patients at Maax Superspecialty Hospitals(Shivamogga,India), from November/2021-October/2023. Previously diagnosed &under treatment elsewhere, referred for/sought expert opinion. These patients had deferred definitive-treatment(fear of complications arising from pre-surgical discussion with physician) or desired radical surgery for low risk lesions where observation was an option("may turn into cancer" as a result of discussion with physician or information obtained from other sources). Multiple consults and difference of opinions also added to this issue. Six questions were asked as a part of self-assessment- Did we add additional information/value with respect to: Q1-Diagnosis? Q2-Overall condition/course-of-disease? Q3-Treatment options? Q4a-Why surgery,Q4b-why observation? Q5-Advanced procedures? Q6-Complications, how we tackle it? Responses were recorded with a 3-point Likert scale: Score-1:No useful/convincing additional information Score-2:New information provided,but not enough to influence TD Score-3:Meaningful additional information, positive influence on TD.
Results:
F:M=147:6. Sixty-nine had multinodular goitre(14:compressive-symptoms, 9:retro-sternal, 3:toxic-MNG, 4:thyroiditis, 33:high-risk, 9:low-risk),18-Graves' disease,12-Diffuse goitre,51-solitary nodules(25:high-risk,26:low-risk). The response and analysis of scores are as follows: Q1- Score-1=2,score-2=85,score-3=66. Q2- Score-1=6,score-2=53,score-3=94. Q3- Score-1=6,score-2=69,score-3=78. Q4a(n=103)- Score-1=2,score-2=18,score-3=83. Q4b(n=50)- Score-1=2,score-2=9,score-3=39. Q5- Score-1=1,score-2=35,score-3=117. Q6- Score-1=2,score-2=31,score-3=120. On multiple regression analysis, Q1-3 did not significantly influence TD, while Q4,Q5 &Q6 resulted in significant change in TD(p-value: <0.001) Q4, Q5 &Q6 strongly correlated with change in TD(ρ=0.79,0.84,1 respectively).
Conclusions:
Dedicated endocrine-surgery unit leads to better acceptance of treatment-plan, reduces fear/anxiety, and unnecessary surgeries. Objective discussion, availability of advanced procedures & reduced fear of complications positively influence TD.