Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis

Li, Zhe; Qiu, Yuxuan; Yuan, Fangyan; Xing, Zhichao; Zhu, Jingqiang; Su, Anping

doi:10.1007/s12020-020-02410-5

Cited by 32 publications

(9 citation statements)

References 61 publications

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“…However, in case of local tumor growth under active surveillance or in case of patient anxiety about active surveillance, RFA could be a valuable minimally invasive strategy in the management of low-risk mPTC. Different studied treatment options for mPTC and its advantages and disadvantages are described in Table 4 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Dijk

Coerts

Gunput

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Papillary microcarcinomas of the thyroid (mPTCs) account for an increasing proportion of thyroid cancers in past decades. The use of radiofrequency ablation (RFA) has been investigated as an alternative to surgery. The effectiveness and safety of RFA has yet to be determined. OBJECTIVE To evaluate the effectiveness and safety of RFA for low-risk mPTC. DATA SOURCES Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to May 28, 2021. STUDY SELECTION Articles reporting on adult patients with mPTC treated with RFA were included. Studies that involved patients with pre-ablation lymph node or distant metastases, recurrence of disease, or extrathyroidal extension were excluded. Final article selection was conducted by multiple reviewers based on consensus. The proportion of eligible articles was 1%.DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted in accordance with the MOOSE guidelines. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. MAIN OUTCOMES AND MEASURESThe primary outcome was the complete disappearance rate of mPTC. Secondary outcomes were tumor progression and complications. RESULTSFifteen studies were included in this meta-analysis. A total of 1770 patients (1379 women [77.9%]; mean [SD] age, 45.4 [11.4] years; age range, 42.5-66.0 years) with 1822 tumors were treated with RFA; 49 tumors underwent 1 additional RFA session and 1 tumor underwent 2 additional RFA sessions. Mean (SD) follow-up time was 33.0 (11.4) months (range, 6-131 months). The pooled complete disappearance rate at the end of follow-up was 79% (95% CI, 65%-94%). The overall tumor progression rate was 1.5% (n = 26 patients), local residual mPTC in the ablation area was found in 7 tumors (0.4%), new mPTC in the thyroid was found in 15 patients (0.9%), and 4 patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected. Three major complications occurred (2 voice changes lasting >2 months and 1 cardiac arrhythmia). Minor complications were described in 45 patients. CONCLUSIONS AND RELEVANCEThe findings of this systematic review and meta-analysis suggest that RFA is a safe and efficient method to treat selected low-risk mPTCs. Radiofrequency ablation could be envisioned as step-up treatment after local tumor growth under active surveillance for an mPTC or initial treatment in patients with mPTCs with anxiety about active surveillance.

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Section: Discussionmentioning

confidence: 99%

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Dijk

Coerts

Gunput

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…The risk factors attributed to the causation of hypothyroidism in various studies include advanced age, female sex, an elevated preoperative TSH level or a normal or high normal value, preoperative hyperthyroidism, autoimmune thyroiditis, multinodular goiter and remnant thyroid volume inferior to 3.2 ml. 2 , 4 , 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

Predictive factors for hypothyroidy after hemithyroidectomy

Châabouni

Sellami²,

Jameleddine³

et al. 2022

F1000Res

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Background: Hemithyroidectomy is one of the most common procedures performed. It is used to treat patients with benign unilateral nodules. Hemithyroidectomy results in fewer risks of hypothyroidism and the need for thyroid hormone replacement therapy. The present study was designed to identify potential clinicopathologic risk factors associated with the onset of biochemical hypothyroidism. Methods: We conducted a retrospective review of all patients who underwent hemithyroidectomy between 2004 and 2019. Hypothyroidism was defined as a serum thyrotropin level greater than 5 mIU/L. The patients were analyzed for age, sex, preoperative and postoperative thyroid stimulating hormone (TSH), state, side, and volume of the remaining lobe, and histologic diagnosis. Results: Hypothyroidism was diagnosed in 30.8% of 214 patients. This complication appeared in the first year in 83.3% of the cases. A preoperative TSH level greater than 1.32 mIU/l, a remaining volume of the lobe less than 3 ml, and the presence of thyroiditis were associated with a significant increase in the risk of developing hypothyroidism (p<0.01). There were no significant differences in age, sex, state, and side of the remaining lobe. The mean thyroxine dose was 57 ± 26 micrograms. Conclusions: The risk of hypothyroidism after hemithyroidectomy should be assessed prior to surgery. Close monitoring is recommended in patients at high risk of developing this complication. However, all patients who undergo hemithyroidectomy should be monitored at least for the first year.

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“…Thyroid hormone supplementation is required after total thyroidectomy, but after thyroid lobectomy, many patients may not need supplementation. The overall rate of hypothyroidism after lobectomy, as analyzed in a recent meta-analysis pooling 51 studies, was 30% [24]. Risk factors for supplementation after lobectomy include lymphocytic thyroiditis, antithyroid antibodies, low remnant lobe volume, higher preoperative TSH levels, and lower preoperative free T4 levels [24,25].…”

Section: Why Thyroid Lobectomy?mentioning

confidence: 99%

“…The overall rate of hypothyroidism after lobectomy, as analyzed in a recent meta-analysis pooling 51 studies, was 30% [24]. Risk factors for supplementation after lobectomy include lymphocytic thyroiditis, antithyroid antibodies, low remnant lobe volume, higher preoperative TSH levels, and lower preoperative free T4 levels [24,25]. For Kandil et al, analyzing 15,412 patients in a different meta-analysis, a preoperative TSH level >2.5 mUI/L was associated with a relative risk of 3.52 for postoperative hypothyroidism.…”

Section: Why Thyroid Lobectomy?mentioning

confidence: 99%

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Hartl

Guerlain

Breuskin

et al. 2020

Cancers

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Many recent publications and guidelines have promoted a “more is less” approach in terms of treatment for low to intermediate risk differentiated thyroid cancer (DTC), which comprise the vast majority of thyroid cancers: less extensive surgery, less radioactive iodine, less or no thyroid hormone suppression, and less frequent or stringent follow-up. Following this approach, thyroid lobectomy has been proposed as a means of decreasing short- and long-term postoperative morbidity while maintaining an excellent prognosis for tumors meeting specific macroscopic and microscopic criteria. This article will examine the pros and cons of thyroid lobectomy for low to intermediate risk cancers and discuss, in detail, criteria for patient selection and oncological outcomes.

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Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis

Cited by 32 publications

References 61 publications

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Predictive factors for hypothyroidy after hemithyroidectomy

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

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