Symptom clusters and contemporaneous symptom network analysis at discharge in patients with differentiated thyroid cancer after thyroidectomy.

OBJECTIVE: To identify symptom clusters and examine the contemporaneous symptom network structure among patients with differentiated thyroid cancer at the time of hospital discharge following thyroidectomy, with the aim of informing early symptom management strategies. METHODS: This cross-sectional study was conducted at a university hospital in China. Symptom burden was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the Thyroid Cancer–Specific Quality of Life Questionnaire (THYCA-QoL). Principal component analysis was used to identify symptom clusters. A contemporaneous symptom network analysis was conducted to determine central and bridge symptoms. RESULTS: A total of 280 patients with differentiated thyroid cancer were included in the study. Four symptom clusters emerged: psycho-somatic, throat-voice, stress response, and sleep-gastrointestinal symptom clusters. Symptom network analysis identified psychological problems (rstrength=5.831, rcloseness=0.028, rbetweenness=17.0) as the most central symptom, and fatigue (r bridge strength =3.971, r bridge closeness =0.374, r bridge expected influence(1−step) = 3.971), which functioned as a key bridge symptom linking different clusters. Psychological problems and fatigue also demonstrated high predictability, 66.7% and 58.2%, respectively, suggesting strong influence on co-occurring symptoms. CONCLUSIONS: Patients with differentiated thyroid cancer experience a multidimensional and complex symptom burden at the time of hospital discharge following thyroidectomy. Within the contemporaneous symptom network, psychological problems and fatigue each exhibited high levels of connectivity to other symptoms, highlighting their clinical relevance at this transition point. These findings support the integration of network-based symptom management into discharge planning and early survivorship care.