Thyroid-specific symptom burden rather than psychological distress following thermal ablation versus open surgery for low-risk thyroid cancer: a 24-month propensity score-matched patient-reported outcome study.

purposeTo compare longitudinal psychological outcomes and health-related quality of life after thermal ablation versus open surgery in carefully selected patients with low-risk thyroid cancer and to identify the domains most associated with differences in patient-reported outcomes.

methodsThis single-center retrospective longitudinal cohort included consecutive patients treated between March and August 2023. After exclusions, 230 patients comprised the pre-matching cohort; 176 (44 thermal ablation, 132 open surgery) formed the primary analytic cohort after 1:3 propensity score matching on age, sex, maximum tumor diameter, and tumor location. HADS, FoP-Q-SF, EORTC QLQ-C30, and EORTC QLQ-THY34 were assessed at 6, 12, and 24 months. Generalized estimating equations were used, with Benjamini-Hochberg correction; IPTW-weighted, nearest-observation imputation, multiple-imputation, whole-table false-discovery-rate, and E-value analyses served as sensitivity analyses. Because pretreatment scores were unavailable and multiple outcomes were examined, analyses were regarded as exploratory.

resultsAfter matching, baseline covariates and follow-up completion were comparable between groups. Thermal ablation was associated with higher global health/QoL, physical, role, and social functioning and lower pain at 6 months. More consistently, it was associated with lower head and neck discomfort, voice problems, swallowing problems, and body-image concerns at 6, 12, and 24 months, and with lower shoulder function limitation at 24 months. Anxiety, depression, HADS total score, and fear of progression did not differ significantly. Principal sensitivity analyses were directionally concordant.

conclusionIn selected patients with low-risk thyroid cancer, thermal ablation was associated with better early functional recovery and lower sustained thyroid-specific symptom burden, but not with measurable differences in psychological distress. Because the design was observational and lacked baseline scores, these associations are exploratory and should be confirmed prospectively before any causal interpretation. They nonetheless support incorporating longitudinal patient-reported outcomes into shared decision-making.