Psychological distress and sleep disturbance throughout thyroid nodule screening, diagnosis and treatment: a monoinstitutional prospective study (Preprint)

BACKGROUND Many controversies exist regarding the screening and treatment of thyroid cancer (TC), especially papillary thyroid microcarcinoma (PTMC). Numerous articles emphasize patients’ physical health, but few focus on psychological health. OBJECTIVE The aim of this study was to evaluate patients’ psychological distress and sleep disturbance throughout thyroid nodules (TNs) screening, diagnosis and treatment. METHODS Initially, 2905 eligible participants were enrolled, but some subjects were gradually excluded in different stages. Ultimately, 2834 participants (1153 participants with TNs) were enrolled during the screening phase, and 1105 individuals (87 individuals with TC) were enrolled during the diagnosis phase. Of the 87 TC patients, 66 patients underwent immediate operation (OP), and 21 patients with PTMC opted for active surveillance (AS). Four commonly used questionnaires were applied to quantify the outcome indicators at prescreening, postscreening, postdiagnosis and posttreatment. RESULTS Higher psychological distress and sleep disturbance were found postscreening than prescreening, except among those without nodules. Compared to postscreening, higher scores of psychological distress and sleep disturbance were identified in patients with suspicious TC (thyroid imaging reporting and data system ≥4) treated with fine needle aspiration (FNA) or AS , but no significant differences were found between the FNA group and AS group. Lower psychological distress and sleep disturbance were noted for benign nodule patients than for TC patients. OP for papillary thyroid cancer (PTC), especially PTMC, did not alleviate psychological distress or sleep disturbance compared with the same parameters in patients who underwent AS. CONCLUSIONS Based on the findings of impaired psychological health and sleep quality, screening for TNs in adults who show no symptoms should be performed with caution. Psychological distress and sleep disturbance should also be taken into consideration when FNA is performed for suspected TC or OP for PTC, especially PTMC.