Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy

Abstract

Context: Lobectomy is preferred in thyroid cancer to decrease surgical complications and avoid lifelong thyroid-hormone replacement. However, postoperative hypothyroidism, requiring thyroidhormone replacement, may occur.Objective: We aimed to identify the incidence and risk factors of postoperative hypothyroidism to develop a surveillance strategy after lobectomy for papillary thyroid microcarcinoma (PTMC).Methods: This historical cohort study involved 335 patients with PTMC treated by lobectomy. Postoperative thyroid functions were measured regularly, and patients were prescribed levothyroxine according to specific criteria. Patients not satisfying hormone-replacement criteria were closely followed up.Results: Postoperative hypothyroidism occurred in 215 patients (64.2%) including 5 (1.5%) with overt hypothyroidism and 210 (62.7%) with subclinical hypothyroidism. Forty patients (11.9%) were required thyroid hormone replacement. One hundred nineteen patients (33.5%) experienced temporary hypothyroidism and spontaneously recovered to euthyroid state. High preoperative thyroid-stimulating hormone (TSH) was the most important factor predicting postoperative hypothyroidism and failure of recover from hypothyroidism (odds ratio [OR], 2.82 and 1.77; 95% confidence interval [CI], 2.07 to 3.95 and 1.22 to 2.63; P , 0.001 and 0.002, respectively). Of the 215 patients eventually developing postoperative hypothyroidism, 70 (32.6%) developed hypothyroidism after the first postoperative year. Postoperative 1-year TSH levels were able to differentiate patients developing late hypothyroidism or euthyroidism (OR, 2.29; 95% CI, 1.68 to 3.26; P , 0.001).Conclusions: Preoperative and postoperative TSH levels might be predictive for patients who develop postlobectomy hypothyroidism and identify those requiring long-term surveillance for hypothyroidism. Additionally, mild postoperative hypothyroidism cases should be followed up without immediate levothyroxine replacement with the expectation of spontaneous recovery.

Analysis of patterns and risk factors regarding the onset of nodules in the contralateral thyroid lobe during follow‐up ultrasonography among patients after unilateral lobectomy for the treatment of papillary thyroid carcinoma

“…However, these advantages declined as RAI ablation had been called off in low‐risk patients due to questions regarding its contributions and complications . In fact, lobectomy was generally performed at our hospital in patients with a nodule‐negative result in the contralateral thyroid lobe confirmed by preoperative ultrasonography because it met a lower dose of hormone replacement therapy and showed lower incidence of complications such as postoperative bleeding, hypoparathyroidism and nerve injury compared with TT . In contrast to existing studies concerning the survival outcomes and recurrence incidence such as overall survival (OS) or disease‐free survival (DFS) between lobectomy and TT, this retrospective study focused on the patterns and risk factors regarding the onset of new nodules in the contralateral lobe among PTCs who had received lobectomy.…”

Апоптоз Лімфоцитів Крові У Хворих На Автоімунний Тиреоїдит І Шляхи Корекції

“…Насамперед це стосується вузлових форм зоба та пухлин, вузлового зоба на тлі АІТ [4,5]. Зі збільшенням кількості пролікованих хірургічним методом хворих зростає і кількість випадків післяопераційного гіпотиреозу [6]. Застосування синтетичних препаратів тиреоїдних гормонів хоча й вирішує проблему компенсації функції ЩЗ, але досягає цього не завжди [7].…”

Reduced Gene Expression of Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1α in Whole Blood in Euthyroid Patients One Year After Hemithyroidectomy for Benign Euthyroid Goiter

“…Eligible for enrollment was a total of 106 patients, scheduled to undergo HT between June 1, 2011 and July 1, 2012 at the Department of Otorhinolaryngology -Head and Neck surgery, Slagelse Hospital, Region Zealand, Denmark. Of the 106 patients, 55 patients fulfilled the following inclusion criteria and were consecutively invited to the study: (1) no previous goiter surgery, (2) no previous radioiodine treatment for goiter, (3) no previous or present medical treatment of hyperthyroidism or hypothyroidism, (4) pre-HT value of TSH in the laboratory reference range (0.3-4.0 mIU/l), (5) benign pathologic diagnosis of resected tissue, (6) preoperative body mass index (BMI) between 20-35 kg/m 2 , (7) no endocrine diseases, and (8) age between 18 and 75 years. Values of preoperative TSH were obtained from the non-fasting venous blood sample drawn at the routine examination prior to HT.…”

“…Approximately one third of euthyroid patients who undergo hemithyroidectomy (HT) develop hypothyroidism [1][2][3][4]. Thus, the majority of hemithyroidectomized patients remain biochemically euthyroid, but with increased serum levels of thyroid stimulating hormone (TSH) compared to preoperative levels, indicating post-HT lowered thyroid function [5].…”