Prediction of Thyroid Hormone Replacement Following Thyroid Lobectomy: A Long‐term Retrospective Study

Abstract

Objective Following thyroid lobectomy, patients are at risk for hypothyroidism. This study sought to determine the incidence of postlobectomy thyroid hormone replacement as well as predictive risk factors to better counsel patients. Study Design Retrospective cohort study. Setting Patients aged 18 to 75 years treated in a single academic institution who underwent thyroid lobectomy from October 2006 to September 2017. Methods Patients were followed for an average of 73 months. Demographic data, body mass index, size of removed and remnant lobe, preoperative thyroid-stimulating hormone (TSH) level, final thyroid pathology, and presence of thyroiditis were collected and analyzed. Risk factors were evaluated with chi-square analyses, t tests, logistic regression, and Kaplan-Meier analysis. Results Of the 478 patients reviewed, 369 were included in the analysis, 30% of whom eventually required thyroid hormone replacement. More than 39% started therapy >12 months postoperatively, with 90% treated within 36 months. Patient age ≥50 years and preoperative TSH ≥2.5 mIU/L were associated with odds ratios of 2.034 and 3.827, respectively, for thyroid hormone replacement. Malignancy on final pathology demonstrated an odds ratio of 7.76 for hormone replacement. Sex, body mass index, volume of resected and remaining lobes, and weight of resected lobe were not significant predictors. Conclusion Nearly a third of patients may ultimately require thyroid hormone replacement. Age at the time of surgery, preoperative TSH, and final pathology are strong, clinically relevant predictors of the need for future thyroid hormone replacement. After lobectomy, patients should have long-term thyroid function follow-up to monitor for delayed hypothyroidism.

Predictors of Hypothyroidism after Thyroid Lobectomy

“…No correlation existed with sex, BMI, and family history (p> 0.05). 6 In the same concern, Cho et al study found that age, sex, follow-up period, and operation type performed were not significant factors for postlobectomy hypothyroidism development. 11 This study observed that the mean preoperative TSH level was significantly higher in patients who developed postlobectomy hypothyroidism (p¼ 0.001).…”

“…No correlation existed with sex, BMI, and family history ( p > 0.05). 6 In the same concern, Cho et al study found that age, sex, follow-up period, and operation type performed were not significant factors for postlobectomy hypothyroidism development. 11…”

“…11 Similarly, Park et al reported that preoperative TSH levels differed significantly between patients with postoperative hypothyroidism and those with postoperative euthyroidism, 20 which agreed with the results of other studies like Lang et al in which hypothyroidism was associated with a higher preoperative TSH level and Meyer et al which report that postlumpectomy hypothyroidism was associated with a higher preoperative TSH. 6,16 Subclinical thyroiditis can be detected through increased autoantibodies preoperatively. 11 This study proves that thyroid autoimmunity is a valuable predictor of postoperative hypothyroidism.…”

“…It is a relevant clinical predictor of future hypothyroidism and the need for thyroid hormone replacement. 6 Higher preoperative TSH level translates into higher posthemithyroidectomy hypothyroidism. However, a definite cutoff point has yet to be established.…”

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy

“…Additionally, the alterations encompassed regular thyroid profile assessments within a six to eight-week interval and inquiries about hypothyroidism symptoms during follow-up visits. These changes were implemented between May 2022 and July 2022, marking the completion of the second cycle [ 13 ].…”