Thyroidectomy is more effective than medical management for relieving persistent symptoms in euthyroid patients with Hashimoto disease, according to results from a Norwegian trial.

“Thyroidectomy should be the standard of care when the patient still has autoimmune symptoms persisting in a euthyroid state,” Dr Ivar Guldvog from Telemark Hospital, in Skien, said. “The main reason is that there is no alternative.”

Persistent symptoms in patients with Hashimoto disease who remain euthyroid during levothyroxine supplementation are thought to be related to autoimmune disease. Total thyroidectomy removes the antigenic tissue.

Dr Guldvog and colleagues compared the outcomes of total thyroidectomy with those of medical therapy alone in their randomised trial of 150 patients with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone-replacement therapy.