- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04542278
Preoperative Steroids in Autoimmune Thyroid Disease
Randomized Controlled Trial of Preoperative Steroids in Autoimmune Thyroid Disease
Study Overview
Detailed Description
Graves' disease and Hashimoto's thyroiditis are autoimmune conditions affecting the thyroid gland. Surgery to remove the thyroid gland in these patients may be complicated by the inflammatory nature of these diseases. Prednisone is a steroid medication used to decrease inflammation of the thyroid gland in other disease states such as sub-acute thyroiditis, but has not been used systematically to reduce inflammation in patients about to undergo surgery.
This is a pilot project that proposes to randomize a small sample of patients about to undergo surgery for their autoimmune, inflammatory thyroid disease, and determine if a short course of prednisone alters the inflammation of the gland and makes surgery less difficult. This could potentially lead to better outcomes for these patients, as well as increased time to recovery and improved quality of life.
This project proposes to administer short quality of life surveys at three time points, as well as draw additional labs to measure inflammation and antibody levels at times when patients will already be getting labs drawn for clinical purposes. The purpose of this study is to generate preliminary data from which a larger, blinded, placebo-controlled trial could be designed.
These specific aims are:
Determine the benefits and safety of preoperatively administered prednisone for patients with autoimmune thyroid disease undergoing thyroidectomy on:
- Difficulty of surgery and rates of surgical complications
- Serum autoantibody levels
- Longitudinally assess the impact of surgical treatment on QoL in patients with autoimmune thyroid disease
Update: Protocol amendment approved on 10-22-2020: Study team decided to omit the aim 'antibody-mediated cytokine levels' from the protocol and consent process as it became cost-prohibitive for processing and storage fees. Cytokine levels are not something typically collected or tracked in the course of clinical care, and may not be relevant. Study can proceed without this aim and will not alter the main outcome measures of antibody levels and difficulty of the operation.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Wisconsin
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Madison, Wisconsin, United States, 53792
- University of Wisconsin Hospital and Clinics
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Graves' disease or Hashimoto's disease with positive thyroid autoantibodies (Thyroglobulin Antibody [TgAb], Thyroid peroxidase antibody [TPO], Thyroid Stimulating Ig antibody [TSI], and/or Thyrotropin Receptor antibody [TRAb]).
- Participants will be invited to join the study after the decision has been made to proceed with thyroidectomy as the clinical treatment of their autoimmune thyroid disease.
Exclusion Criteria:
- Pediatric patients < 18
- Prior treatment with radioactive iodine (RAI)
- Known diagnosis of thyroid cancer
- Diabetic patients.
- Patients on any immunosuppressive regiment (such as organ transplant patients or patients treated for other autoimmune condition)
- Pregnant patients.
- Patients being treated for active infection.
- Any patient for whom the surgeon feels steroids would provide a clear benefit (ie. Extremely high auto-antibody levels with a very large, inflamed thyroid gland) will be treated according to the clinical judgement of the surgeon. If a surgeon feels steroids are indicated and prescribes them, the patient will not be eligible for the trial.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Steroids
Participants randomized to the steroid arm will be given a prescription for prednisone 20mg daily for 7 days prior to surgery, otherwise, pre-operative standard of care
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used to reduce inflammation
Other Names:
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No Intervention: No Steroids
Pre-operative Standard of Care
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Thyroid Difficulty Scale Score
Time Frame: surgery occurs up to 4 weeks, data collected a conclusion of operation
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The surgeon will fill out the "Thyroid Difficulty Scale" at the conclusion of the operation.
This is a 4-item survey to rate the vascularity, friability, mobility, and glandular size of the thyroid.
The total possible range of scores from 4-20, higher scores indicate increased difficulty in thyroid surgery
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surgery occurs up to 4 weeks, data collected a conclusion of operation
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Percent Change From Baseline Mean in Autoantibody Levels
Time Frame: baseline measure day of surgery (up to 4 weeks), up to 6 weeks (2 weeks post-op), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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Autoantibodies that may be positive include: Thyroglobulin Antibody [TgAb], Thyroid peroxidase antibody [TPO], Thyroid Stimulating Ig antibody [TSI], and/or Thyrotropin Receptor antibody [TRAb].
Any that were positive pre-op will be measured at each time point.
Baseline level will be 1.
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baseline measure day of surgery (up to 4 weeks), up to 6 weeks (2 weeks post-op), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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Change in Antibody-mediated Cytokine Levels
Time Frame: baseline (2-4 weeks prior to surgery), up to 4 weeks (Post Operative Day 1), up to 6 weeks (2 weeks post-op), up to 30 weeks (6 months post-op)
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Antibody-mediated cytokine levels will be measured using a 10 cytokine panel from Luminex.
Cytokines that have been implicated in other autoimmune disease include: IFN-gamma (BR29), IL-6 (BR13), IL-10 (BR22), IL-13 (BR47), IL-15 (BR63), IL-17A (BR42), and VEGF-C (BR38).
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baseline (2-4 weeks prior to surgery), up to 4 weeks (Post Operative Day 1), up to 6 weeks (2 weeks post-op), up to 30 weeks (6 months post-op)
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Change in Short Form Health Survey (SF-12) Mental Component Score (MCS)
Time Frame: baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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The SF-12 is a 12-item quality of life survey to understand how the participant feels and how well they are able to do their normal activities, it is composed of the mental component score and the physical component score.
Each is scored on a scale of 0-100, with higher numbers indicating higher quality of life.
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baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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Change in Short Form Health Survey (SF-12) Physical Component Score (PCS)
Time Frame: baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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The SF-12 is a 12-item quality of life survey to understand how the participant feels and how well they are able to do their normal activities, it is composed of the mental component score and the physical component score.
Each is scored on a scale of 0-100, with higher numbers indicating higher quality of life.
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baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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Change in Thyroid-specific Quality of Life Patient-reported Outcome Measure for Benign Thyroid Disorders (ThyPRO) Score
Time Frame: baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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The ThyPRO survey is a quality of life measure designed to evaluate how thyroid disease has affected the participant's life.
It is a 39-item survey that was scored from 0-4, higher scores indicate worse quality of life.
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baseline (2-4 weeks prior to surgery), up to 10 weeks (6 weeks post-op), up to 30 weeks (6 months post-op)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ultrasound Doppler Quantification of Blood Flow
Time Frame: baseline (2-4 weeks prior to surgery), up to 4 weeks (Post Operative Day 1)
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baseline (2-4 weeks prior to surgery), up to 4 weeks (Post Operative Day 1)
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Surgical Complications: Parathyroid Hormone (PTH) Level
Time Frame: immediately after surgery (baseline for all participants)
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PTH is measured right after surgery to determine whether the nearby parathyroid glands were injured during surgery.
Low PTH levels immediately after surgery are concerning for symptomatic low calcium levels, either temporarily or permanent, after thyroidectomy.
Normal PTH is typically between 20-70.
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immediately after surgery (baseline for all participants)
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Number of Participants With Surgical Complications: Recurrent Laryngeal Nerve (RLN) Injury
Time Frame: up to 4 weeks (Post Operative Day 1)
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up to 4 weeks (Post Operative Day 1)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Dawn K Elfenbein, University of Wisconsin, Madison
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2020-0209
- Protocol Ver October 2020 (Other Identifier: UW Madison)
- A539711 (Other Identifier: UW Madison)
- SMPH/SURGERY/ENDOCRINE (Other Identifier: UW Madison)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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