Predictors of thyroxine replacement following hemithyroidectomy in a south east Asian cohort

Ng, Peng; Ho, Collin Yih Xian; Tan, Wee Boon; Ngiam, Kee Yuan; Lim, Chwee Ming; Loh, Kwok Seng; Nga, Min En; Parameswaran, Rajeev

doi:10.1002/hed.25592

Cited by 13 publications

(21 citation statements)

References 28 publications

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“…In this study, we separately evaluated patients with subclinical hypothyroidism; this subgroup has not been adequately assessed in previous studies [ 19 , 20 ]. In our sample, 25% of patients with subclinical hypothyroidism following hemithyroidectomy reverted to euthyroidism without TH replacement.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram

Cao

et al. 2022

Endocrine

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Purpose Hemithyroidectomy is a valid operation to retain functional contralateral thyroid lobe that is indicated for a variety of thyroid diseases. This study aimed at determination of the risk factors for thyroid hormone replacement following hemithyroidectomy and to develop a predictive nomogram. Methods Data of patients treated by hemithyroidectomy for benign thyroid disease between January 2015 and January 2020 were retrospectively analyzed. Baseline characteristics, surgery-related variables, and preoperative and postoperative thyroid function of patients were collected from the case records and compared between patients with postoperative euthyroidism and patients with postoperative hypothyroidism. Postoperative euthyroidism patients without thyroid hormone replacement were compared to those who developed postoperative hypothyroidism with thyroid hormone replacement. The factors associated with thyroid hormone replacement were used to construct a binomial logistic-regression model and visualized as a predictive nomogram to evaluate the risk of thyroid hormone replacement following hemithyroidectomy. Results Of the 378 patients (74% female) included in the study, 110 (29.1%) developed postoperative hypothyroidism. Preoperative serum thyroid-stimulating hormone (TSH) > 2.172 μIU/mL was identified as an independent risk factor for postoperative hypothyroidism (odds ratio [OR] = 8.02; 95% confidence interval [CI]: 4.87–13.20; P < 0.001). Of 110 patients with postoperative hypothyroidism, 56 (50.9%) received thyroid hormone replacement. Unilateral thyroid nodule and preoperative serum TSH > 2.172 μIU/mL were independent predictors of postoperative thyroid hormone replacement ( P = 0.01, and P < 0.001, respectively). Temporary subclinical hypothyroidism occurred in 12 patients; all 12 reverted to euthyroid state without thyroid hormone replacement. The discriminative effect of the binomial regression model was proved reliable by the Hosmer–Lemeshow goodness-of-fit test ( P = 0.503), and predictive ability of the nomogram was satisfactory with a C-index of 0.833. Conclusions Hypothyroidism is common after hemithyroidectomy, and almost half of the patients will need thyroid hormone replacement. Elevated preoperative serum TSH level and unilateral thyroid nodule were independent predictors of thyroid hormone replacement following hemithyroidectomy. The predictive nomogram could be a useful tool for clinical practice.

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Section: Discussionmentioning

confidence: 99%

Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram

Cao

et al. 2022

Endocrine

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“…Histological HT, the most common autoimmune disease ( 27 ), was the second predictor of postoperative hypothyroidism. Peng Ng et al ( 28 ) reported that HT was the only independent risk factor in a retrospective review of 901 patients. The presence of thyroid antibodies was found to be a significant factor by univariate analysis but did not maintain independence as a factor for postoperative hypothyroidism by multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

The Recovery of Thyroid Function in Low-Risk Papillary Thyroid Cancer After Lobectomy: A 3-Year Follow-Up Study

Dou

Chen

et al. 2021

Front. Endocrinol.

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PurposeManagement strategies after lobectomy for low-risk papillary thyroid carcinoma (PTC) are controversial. This study aimed to identify the proportion of patients among low-risk PTC patients who do not require hormone replacement therapy and to evaluate the risk factors for postoperative hypothyroidism after lobectomy.Patients and MethodsThe records of 190 PTC patients who underwent thyroid lobectomy from January 2017 to December 2018 were retrospectively reviewed. Clinicopathological characteristics and follow-up data were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with postoperative hypothyroidism and the recovery of thyroid function.ResultsIn summary, 74.21% of patients (141/190) had normal thyroid function without levothyroxine supplementation, while 40.53% (77/190) developed temporary or permanent hypothyroidism. Multivariate analysis indicated that higher preoperative thyroid-stimulating hormone (TSH) levels (>2.62 mIU/L), Hashimoto’s thyroiditis (HT), and right lobectomy were associated with hypothyroidism (all P<0.05). The Area Under Curve (AUC) by logistic analysis was 0.829. Twenty-eight (28/77, 36.4%) patients recovered to the euthyroid state in the first year after surgery, and this recovery was significantly associated with preoperative TSH level. Forty-nine (49/77, 63.6%) patients developed persistent hypothyroidism. The thyroid function of most patients (11/28, 39.3%) recovered in the third month after surgery.ConclusionPatients with a lower level of preoperative TSH, with left lobectomy and without Hashimoto’s thyroiditis had a higher chance of normal thyroid function within the first year after lobectomy. The recovery of thyroid function was associated with the level of preoperative TSH.

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“…Additionally, these studies reported that postoperative hypothyroidism is mostly subclinical, and that patients recover spontaneously, in many cases. Relatively well-known risk factors for postoperative hypothyroidism have been mentioned, such as preoperative TSH level, thyroiditis, and anti-thyroid peroxidase (TPO) antibody (3)(4)(5)(6)(7).…”

Section: Original Articlementioning

confidence: 99%

Usefulness of 1-year of thyroid stimulating hormone suppression on additional levothyroxine in patients who underwent hemithyroidectomy with papillary thyroid microcarcinoma

et al. 2019

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Background: The purpose of this study was to identify usefulness of 1-year of thyroid stimulating hormone (TSH) suppression, on additional levothyroxine in patients who underwent hemithyroidectomy with papillary thyroid microcarcinoma (PTMC).Methods: Two-hundred consecutive patients who had received hemithyroidectomy February 2011 to March 2013, were enrolled, retrospectively. Group 1, only, was taking levothyroxine for a year, postoperatively. We evaluated postoperative hypothyroidism through serum TSH level, measured periodically.Results: Postoperative TSH >10 was significantly different, at 13% and 25%, between two groups (P=0.036). Twenty patients in group 1, and 32 patients in group 2, received additional levothyroxine.Multivariate analysis showed that 1-year suppression, clinical thyroiditis, and preoperative TSH >2, were significantly associated with additional levothyroxine (OR 2.17, P=0.025 and OR 2.00, P=0.046 and OR 2.64, P=0.006). Too, 1-year TSH suppression, preoperative TSH >2, were also significantly associated with postoperative TSH >10 (OR 2.55, P=0.022 and OR 2.22, P=0.048).

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Predictors of thyroxine replacement following hemithyroidectomy in a south east Asian cohort

Cited by 13 publications

References 28 publications

Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram

Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram

The Recovery of Thyroid Function in Low-Risk Papillary Thyroid Cancer After Lobectomy: A 3-Year Follow-Up Study

Usefulness of 1-year of thyroid stimulating hormone suppression on additional levothyroxine in patients who underwent hemithyroidectomy with papillary thyroid microcarcinoma

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