The Impact of Thyroidectomy and Lobectomy on Patients’ Health-Related Quality of Life, Eastern Region, Saudi Arabia
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Thank you for submitting your manuscript. The study addresses an important topic, providing valuable insights into the effects of thyroidectomy on patients' HRQoL in a specific demographic context. The use of the SF-36 questionnaire to evaluate HRQoL is appropriate and well-executed. However, there are several areas where improvements could be made, which I have outlined below:
(1) I recommend providing more detailed information on the selection criteria for participants, particularly how potential biases were mitigated during the recruitment process
(2) Please clarify the rationale for the chosen study duration and how it ensures the inclusion of both short-term and long-term postoperative outcomes
(3) Please provide more context for the clinical implications of your findings and how they can influence future diagnostic and therapeutic approaches for thyroidectomy patients
(6) Consider discussing any potential limitations of the study, particularly the cross-sectional nature and any potential biases introduced by the recruitment and data collection methods
(7) I suggest providing more detailed comparisons with existing literature to highlight the novelty and significance of your findings
By addressing these points, the manuscript will be significantly strengthened, providing clearer and more actionable insights for clinicians and researchers in the field of endocrinology and thyroid surgery.
Comments on the Quality of English Language
The English language quality of the manuscript is generally good. However, there are minor instances where clarity and readability could be improved. For example:
- In the introduction, the sentence "Thus, it demands a concern in knowing the impact of thyroid surgery on a patient’s health-related quality of life (HRQoL)" could be improved to "Thus, it is important to understand the impact of thyroid surgery on patients' health-related quality of life (HRQoL)."
- In the methods section, the sentence "All patients with met the eligibility criteria were recruited in the study" could be revised to "All patients who met the eligibility criteria were recruited into the study."
Author Response
- I recommend providing more detailed information on the selection criteria for participants, particularly how potential biases were mitigated during the recruitment process
Response:
Thank you for bringing this point to our attention. We would like to confirm that potential biases were mitigated during the recruitment process, especially the research team was supervised by an endocrine surgeon and he is the head of endocrine surgery unit at the allocated hospital.
Our research team worked diligently to ensure that the study aim was clearly allocated, and we recruited patients with both benign and malignant thyroid diseases who had undergone thyroidectomy at the endocrine surgery unit. The inclusion and exclusion criteria were designed based on several reports in this regard to minimize any potential biases. Additionally, we have included a new point in the updated manuscript to confirm the visibility of included participants, which will further ensure the transparency of our study. Moreover, the research team is headed by endocrine surgeon and he is the head of of endocrine surgery at King Fahd hospital of the University
- Please clarify the rationale for the chosen study duration and how it ensures the inclusion of both short-term and long-term postoperative outcomes
Response:
The chosen duration based on previous experienced post thyroid surgery that ensure both short- and long-term complication.
A new paragraph has added in the method section to highlight this point.
https://pubmed.ncbi.nlm.nih.gov/17500171/
https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.26176?casa_token=bMP1DlArYkMAAAAA:w87x0UVjzhVTJ-zrusbYydVN9QbBu3NQ7VuWzpGMNj0ep6Ot9Xn9KT-lxw4JdLEnqBxlclLQxaQMu1-E7A
- Please provide more context for the clinical implications of your findings and how they can influence future diagnostic and therapeutic approaches for thyroidectomy patients
Response
Thank you so much for this valid point, the manuscript has included two paragraphs highlighting these important points.
(6) Consider discussing any potential limitations of the study, particularly the cross-sectional nature and any potential biases introduced by the recruitment and data collection methods
Response
Thank you we have added a new paragraph for the limitation
(7) I suggest providing more detailed comparisons with existing literature to highlight the novelty and significance of your findings
Response
Thank you so much I have amendment the manuscript on the light of this value comments and the gap of knowledge of our studies now appear more prominent.
By addressing these points, the manuscript will be significantly strengthened, providing clearer and more actionable insights for clinicians and researchers in the field of endocrinology and thyroid surgery.
Comments on the Quality of English Language
The English language quality of the manuscript is generally good. However, there are minor instances where clarity and readability could be improved. For example:
- In the introduction, the sentence "Thus, it demands a concern in knowing the impact of thyroid surgery on a patient’s health-related quality of life (HRQoL)" could be improved to
"Thus, it is important to understand the impact of thyroid surgery on patients' health-related quality of life (HRQoL)."
Response
Thank you, done
- In the methods section, the sentence "All patients with met the eligibility criteria were recruited in the study" could be revised to "All patients who met the eligibility criteria were recruited into the study."
Response
Corrected Thank you.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear authors,
Thanks for your work
But please address the following remarks,
1- Title: "benign and malignant" is a description of the disease, but not the operation. please modify
2- Abstract: The first sentence is too general and does not add to the context "The thyroid gland is one of the most important glands in the body"
3- What was the indication of surgery in hyperthyroidism patients?
4- What is meant by the exclusion of patients operated by a non-endocrine surgeon? Thyroidectomy can be safely performed by a trained general surgeon and by a surgical oncologist
5- Please explain how the sample size was calculated
6- The clinical and pathological data of the included patients were not explained at all
7- It is not explained whether the patient with malignant thyroid tumors who underwent total thyroidectomy had undergone central or lateral neck dissection or not
8- Figures 1 & 2 do not add much to the context
9- To prove that patients' education and their occupation status affected QOL needs more investigation/ A control group is suggested
Author Response
- Title: "benign and malignant" is a description of the disease, but not the operation. please modify
Response:
Thank you we corrected the title
- Abstract: The first sentence is too general and does not add to the context "The thyroid gland is one of the most important glands in the body"
Response
Done
- What was the indication of surgery in hyperthyroidism patients?
Response
Thank you for this comment, as mentioned in the inclusion criteria: obstructive symptoms/goiter, hyperthyroidism, and thyroid cancer.
- What is meant by the exclusion of patients operated by a non-endocrine surgeon? Thyroidectomy can be safely performed by a trained general surgeon and by a surgical oncologist.
Response:
An endocrine surgeon should perform thyroid surgery due to their expertise, personalized approach, and use of minimally invasive techniques. More, importantly according to the reported evidences, Endocrine surgeon provide comprehensive care, including preoperative evaluation, intraoperative management, and postoperative follow-up. This comprehensive approach helps ensure that patients receive the best possible care throughout their treatment. All these can control the confounder.
https://pubmed.ncbi.nlm.nih.gov/32079830/
https://pubmed.ncbi.nlm.nih.gov/36002375/
- Please explain how the sample size was calculated
Response
We want to thank the reviewer for his valid concern. As mentioned in the manuscript: ‘All patients who met the eligibility criteria were recruited into the study”. Furthermore, a general guideline is to have at least 30 participants per scale to ensure reliable and valid results.
Elagib, Meysoon Adil Abdelrahman, and Omer Eladil Abdalla Hamid. "The Health-related Quality of Life of Sudanese Patients with Idiopathic Parkinson’s Disease." (2020).
- The clinical and pathological data of the included patients were not explained at all
Response
According to study objectives and with reference to other studies: HRQoL is tools used to measure an individual's or group's perceived physical and mental health over time. These surveys typically include questions that assess various aspects of health, such as physical functioning, pain, emotional well-being, and social functioning. The purpose of HRQL surveys is to provide a comprehensive understanding of an individual's health status and how it affects their daily life. s used the same tool:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955103/
https://www.nature.com/articles/s41598-020-62731-3
- It is not explained whether the patient with malignant thyroid tumors who underwent total thyroidectomy had undergone central or lateral neck dissection or not
Response:
Thank you for this comment. We have address this point in the updated version.
8- Figures 1 & 2 do not add much to the context
Response
It is a part of a description of patients features. However, If the respected author suggests to delete them we will do
9- To prove that patients' education and their occupation status affected QOL needs more investigation/ A control group is suggested
Response
We would like to take the attention of the reviewer that HQRoL is often used in medical research and clinical practice to evaluate the effectiveness of treatments, and monitor patient outcomes. It has been widely used in various studies and has been shown to be a reliable and valid measure of HRQOL through special recording calculation and accordingly no need to investigate a control group.
- McHorney, C.A.; Ware Jr, J.E.; Lu, J.R.; Sherbourne, C.D. The MOS 36-Ltem Short-Form Health Survey (SF-36): III. Tests of Data Quality, Scaling Assumptions, and Reliability across Diverse Patient Groups. Medical care 1994, 32, 40–66.
- Coons, S.J.; Alabdulmohsin, S.A.; Draugalis, J.R.; Hays, R.D. Reliability of an Arabic Version of the RAND-36 Health Survey and Its Equivalence to the US-English Version. Medical care 1998, 36, 428–432.
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsDear authors,
Thanks for your reply
But still, some comments need to be addressed
1- The reply to the question about the indications of surgery in hyperthyroidism did not answer the question. The authors just said that hyperthyroidism was one of the inclusion criteria. So I will repeat the question more clearly: Hyperthyroidism alone does not justify surgery. What was the indication of surgery in patients with hyperthyroidism in your cohort?
2- The same for the question about endocrine surgeons. The question was NOT why the authors included endocrine surgeons but it was why they excluded trained surgical oncologists and general surgeons.
3- Also, the sample size calculation method is still not clear.
4- Please explain in more detail how you explain the relation between education, occupation status and the HQRoL
Author Response
Dear Reviewer
We appreciate the time and effort you took to review our manuscript. We are pleased to report that we have addressed all of your comments and hope that this revised version meets your expectations for publication. We believe that the changes we have made significantly improve the clarity, accuracy, and overall quality of the manuscript.
1. The reply to the question about the indications of surgery in hyperthyroidism did not answer the question. The authors just said that hyperthyroidism was one of the inclusion criteria. So I will repeat the question more clearly: Hyperthyroidism alone does not justify surgery. What was the indication of surgery in patients with hyperthyroidism in your cohort?
Response
Thank you so much for the clarification. We added the requested information in the manuscript.
2- The same for the question about endocrine surgeons. The question was NOT why the authors included endocrine surgeons but it was why they excluded trained surgical oncologists and general surgeons.
Response:
We would like to inform the respected reviewer that our institute as a teaching hospital of the university, limits thyroid surgery to the Endocrine/ thyroid surgeon at the endocrine surgery unit. Importantly, according to the allocated sample size, the needed patient number has been covered by the endocrine surgery unit. Therefore, from an ethical point of view, we have to report this in the manuscript. Finally, and according to the literature, such work should be run by the same surgical team.
https://link.springer.com/article/10.1007/s00268-019-05180-y
3- Also, the sample size calculation method is still not clear.
Response:
Upon return to the biostatistician who ran the test, he provided us with the sample size calculation which is now incorporated into the manuscript
4- Please explain in more detail how you explain the relation between education, occupation status and the HQRoL
Response
Thank you for this comment which I am sure will enrich our manuscript. We added two paragraphs explaining the relationship between education, occupational status and the HRQoL
Round 3
Reviewer 2 Report
Comments and Suggestions for AuthorsThanks for the replies and the modifications performed in the article
