Health-Related Quality of Life and Voice Outcomes after Total Thyroidectomy - A Cross-Sectional Study Using the ThyPRO-39 and Voice Handicap Index-10 in a Moroccan Cohort

Abstract

Background: Total thyroidectomy is the standard treatment for multinodular goiter and differentiated thyroid carcinoma, but biochemical euthyroidism does not guarantee patient well-being. Data on patient-reported outcomes after TT remain scarce in North Africa and in populations with limited health literacy.

Objective: To evaluate health-related quality of life (QoL) and voice-related handicap after TT and to identify their clinical, biological, and sociodemographic determinants.

Methods: We conducted a cross-sectional, observational, analytical study of 82 adults who underwent TT (with or without neck dissection) and had ≥ 6 months of postoperative follow-up at the Department of Otorhinolaryngology–Head and Neck Surgery, Hôpital 20 Août 1953, Ibn Rochd University Hospital Center, Casablanca, Morocco (June 2024–July 2025). Because 80.5% of participants had no formal education, both the ThyPRO-39 (thyroid-specific QoL questionnaire) and the Voice Handicap Index-10 (VHI-10) were administered as a structured interview using a Moroccan Arabic (Darija) linguistic adaptation rather than self-administration. Bivariate associations were assessed with Student's t-test and Pearson correlation (r).

Results: The cohort was predominantly female (90.2%; mean age 51.0 ± 11.8 years). Papillary carcinoma accounted for 58.5% of final histology, and multinodular goiter was the leading indication (95.1%). Permanent dysphonia occurred in 12.2% of patients and symptomatic hypocalcemia in 4.9%. The mean VHI-10 score was 1.88 ± 5.39 (median 0), rising to 10.4 ± 11.0 in patients with permanent dysphonia. The ThyPRO-39 composite QoL score averaged 38.4 ± 27.4/100, driven chiefly by fatigue (59.0 ± 32.1/100, affecting 61% of patients). QoL correlated strongly with anxiety (r = 0.91), depressivity (r = 0.83) and fatigue (r = 0.75), and moderately with vocal handicap (r = 0.36, p < 0.001). Female sex (p < 0.001) and absence of formal education (p = 0.0058) were independent multipliers of impaired QoL, whereas age, comorbidities, extent of surgery, and benign versus malignant histology were not. A lower TSH was associated with greater fatigue and a worse composite score (r = −0.36, p = 0.005).

Conclusion: Although TT achieves excellent oncological and surgical safety outcomes, a substantial subset of patients remains "biochemically cured but functionally impaired," burdened chiefly by fatigue, anxiety, and - when present - vocal handicap. Individualized TSH targets, systematic screening for fatigue and voice complaints, and simplified therapeutic education for patients with low health literacy should be integrated into routine post-thyroidectomy follow-up.