Acupuncture for the Treatment of Fatigue after Total Thyroidectomy in Women with Papillary Thyroid Cancer: A Pilot Study

Objectives: Papillary thyroid cancer (PTC) is the most common type of thyroid cancer and the most common endocrine malignancy. Although it has a good prognosis, patients experience weight gain, fatigue, and neck pain after total thyroidectomy, and quality of life (QOL) can also decline. There is no effective treatment for these symptoms. This study evaluated the feasibility and safety of acupuncture for treating of fatigue in patients with PTC after total thyroidectomy. Methods: This is a prospective randomized controlled study using before and after measurements. The subjects included 25 patients with thyroid cancer who had undergone total thyroidectomy and were experiencing fatigue. Twelve patients underwent Saam (or Sa-Ahm) acupuncture treatment and thirteen subjects did not. Saam acupuncture, which is one of the original therapeutic modalities representing traditional Korean medicine, is a unique treatment method that has a different origin than the modalities from China and Japan. The basic characteristic of combining five shu points in Saam acupuncture is the selection of the tonification and sedation points along the self-meridian and other meridians based on creation and governor relationships. Acupuncture treatment was delivered two times a week for 6 weeks, in 25 to 30 minutes at each session. Acupoints were individually tailored according to the individual pattern of each patient. Fatigue severity and QOL were evaluated using the fatigue scale score and Short Form-36 (SF-36), respectively. Fatigue severity scale is a 9-item self-report questionnaire scale developed by Krupp et al. in 1989. SF-36 is a 36-item, patient-reported survey of patient health. Body weight, body mass index, fatigue scale score, and SF-36 score were evaluated pre- and post-treatment, and laboratory tests for biochemical variables were also performed. Results: Fatigue scale score (FSS) significantly improved in the acupuncture group (FSS; 29.92 to 19.50, decrease; 91.7%) compared to the control group (FSS; 29.92 to 31.15, decrease; 46.2%) at post-treatment compared to baseline (p=0.011). SF-36 scores were 74.12 in the acupuncture group and 69.02 in the control group, with no statistically significant difference (p=0.085). Weight change did not differ between the two groups. Liver enzymes such as aspartate aminotransferase were lower in the acupuncture group (27.67 to 24.33 IU/L) than in the control group (20.77 to 24.08 IU/L) (p=0.01). No other biochemical markers differed between the two groups. Conclusions: Acupuncture such as ST-36, CV-4, KI-10, and HT-8 may relieve fatigue and improve QOL in patients PTC who experience fatigue, and reduced QOL after total thyroidectomy without biochemical changes. A larger prospective study is required to confirm these effects.