387 Health-related quality of life following [18F]FDG-PET/CT 7 Introduction Palpable thyroid nodules have a prevalence of approximately 5%. Due to the increased use of imaging techniques for indications unrelated to the thyroid, however, occult thyroid nodules will be detected in up to approximately 65% of the general population [464, 581]. Ultrasound and fine needle aspiration cytology (FNAC) are the first steps in the diagnostic workup [17]. Approximately 25% of cytology results are indeterminate, including atypia of undetermined significance or follicular lesion of undetermined significance (Bethesda III) and (suspicious for a) follicular neoplasm or Hürthle cell neoplasm (Bethesda IV) [18, 464]. Following an established indeterminate cytological diagnosis (including repeat FNAC in Bethesda III nodules) and consideration of clinical features, ultrasound characteristics and the patient’s treatment preferences, diagnostic thyroid surgery is often recommended [17]. To improve the workup of indeterminate thyroid nodules and potentially avoid diagnostic surgery for the approximately 75% benign nodules, a range of additional diagnostics is currently available, including various ultrasound classification systems, molecular testing, and 2-[18F]fluoro-2-deoxyD-glucose positron emission tomography/computed tomography (FDG-PET/CT) [18, 25, 501]. Our recent randomised controlled multicentre trial confirmed that a negative [18F]FDG-PET/CT scan accurately rules out malignancy with a 94% sensitivity, avoiding 40% of futile diagnostic surgeries for benign nodules [38, 501]. Moreover, [18F]FDG-PET/CT proved cost-effective in a Dutch setting, with lower societal lifelong costs while maintaining long-term health-related quality of life (HRQoL) in patients undergoing [18F]FDG-PET/CT-driven management as compared to routine diagnostic surgery or molecular testing [28](EJ de Koster et al., manuscript in preparation)[28, 29]. HRQoL has been studied extensively in both benign and malignant thyroid diseases and is often impaired as compared to the general population [526, 582, 583]. Thyroid surgery negatively affects short-term HRQoL, recovering as the time since surgery passes [526, 584-588]. The consequences of surgery, including long-term postoperative thyroid hormone substitution therapy, potential voice changes, scar cosmesis, and surgical complications such as permanent hypoparathyroidism and vocal cord paralysis, also impair HRQoL [526, 589-592]. In thyroid carcinoma, long-term HRQoL may be worse than in other types of cancer with worse prognosis, partly due to periodic thyroid hormone withdrawal during follow-up [526, 582, 587]. In papillary thyroid microcarcinoma, patients managed by active surveillance had fewer HRQoL problems than patients who underwent hemithyroidectomy [593]. There are few studies, however, on HRQoL in patients managed with or without surgery and additional diagnostics for indeterminate thyroid nodules. Two recent studies showed that molecular testing in Bethesda III/IV nodules resulted in sustained HRQoL for patients managed without surgery
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