Clinical Features of Patients Who Undergo Thyroidectomy with and without Hashimoto's Thyroiditis

Mi-Jin Lee M.D.; Yang-Soo Lim M.D.

doi:10.16956/kjes.2011.11.4.242

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M.D. and M.D.: Clinical Features of Patients Who Undergo Thyroidectomy with and without Hashimoto's Thyroiditis

Review Article

Korean J Endocrine Surg 2011;11(4):242-247.

Published online: 18 December 2011

DOI: https://doi.org/10.16956/kjes.2011.11.4.242

Clinical Features of Patients Who Undergo Thyroidectomy with and without Hashimoto's Thyroiditis

Mi-Jin Lee M.D., Yang-Soo Lim M.D.

Department of Surgery, Wallace Memorial Baptist Hospital, Busan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The study investigated clinical features of patients who underwent thyroid surgery, with and without Hashimoto's thyroiditis.

Methods:

We retrospectively reviewed the medical records of 150 patients who underwent thyroid surgery at the Department of Surgery, Wallace Memorial Baptist Hospital, between January 2007 and December 2008. Patients were divided into two groups according to occurrence or non-occurrence of Hashimoto's thyroiditis, and analyzed them for age, sex, day of hospitalization, duration of drain keeping, operation time, and post-operative complications, including recurrent laryngeal nerve injuries, hypoparathyroidism, hypocalcemia, and adjacent structure injury. There were 24 lobectomies and 126 total thyroidectomies.

Results:

Operation time was longer for patients with Hashimoto's thyroiditis. There was little difference between the two groups with respect to day of hospitalization, duration of draining, or post-operative complications. Of the total thyroidectomy cases without Hashimoto's thyroiditis, 36 patients (37.5%) had transient hypocalcemia and four (4.2%) had permanent hypocalcemia. Of the cases with Hashimoto's thyroiditis, 13 patients (38.2%) had transient hypocalcemia and three (8.8%) had permanent hypocalcemia. Patients undergoing thyroid surgery with Hashimoto's thyroiditis had longer operation times due to increased angiogenesis and fibrosis. No difference was shown for other clinical features or post-operative complications.

Conclusion:

The data strongly indicate that meticulous hemostasis and careful surgical technique, along with an understanding of anatomic variation and surgical experience, leads to a low late of complications following thyroid sur-gery, even for patients with Hashimoto's thyroiditis.

Keywords: Thyroidectomy, Hashimoto's, Thyroiditis, Postoperative complication

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Table 1.

Pre-operative and post-operative diagnosis

Pre-operative diagnosis		Post-operative diagnosis
Papillary thyroid cancer or suspicious	136	Papillary thyroid cancer	138
Nodular hyperplasia	8	Follicular carcinoma	1
Follicular neoplasm	3	Nodular hyperplasia	4
Hurthle cell neoplasm	2	Follicular adenoma	4
Thyrotoxicosis	1	Hurthle cell adenoma	2
		Hashimoto's thyroiditis	1

Table 2.

Comparison with demographics, pathology and complications of patients underwent total thyroidectomy with and withou hashimoto's thyroiditis

	With Hashimoto's thyroiditis	Without Hashimoto's thyroiditis	P value
Patients per groups	34	92
Age (years)	48.7±10.3	49.7±11.2	0.664
Female (%)	33 (97.0%)	80 (87.0%)
Nodule size on permanent biopsy (cm)	1.0±0.6 (0.1∼2.8)	0.9±0.8 (0∼4.2)	0.728
Nodule number on permanent biopsy	1.73±1.32 (1∼6)	1.94±1.18 (0∼8)	0.307
1	16	56
2	9	20
More than 3	9	16
Operation time	200.7±32.0	182.2±30.7	＜0.001
Drain keep duration	5.8±1.2	5.3±2.4	0.276
Day of hospitalization	8.9±2.6	8.3±3.9	0.402
Complication
RLN injury	2	1	0.171
Hoarseness	2	3	0.410
PTG injury	16	56	0.164
Living PTG	2.0±0.9	2.0±0.8	0.938
Paresthesia	12	40	0.927
Hypocalcemia	13	36	0.769
Permanent hypoparathyroidism	3	4	0.158
Another complication	2	13	0.170

Table 3.

Predictability of Hashimoto's thyroiditis through antithyroid antibodies and USG∗ finding

	Sensitivity	Specificity	Positive predictive value	Negative predictive value
ATA positivity^†	67.5%	80.0%	55.5%	87.1%
AMA positivity^‡	55.5%	86.4%	59.5%	84.1%
Both positivity on	47.5%	95.5%	79.2%	83.3%
ATA, AMA
USG positivity^§	60.0%	83.5%	57.1%	85.0%
All positivity on	45.0%	70.9%	100%	100%
ATA, AMA and US	SG

^∗ USG = Ultrasonography;

^† ATA positivity = ATA ≥ 78 U/ml;

^‡ AMA positivity = AMA ≥ 60 U/ml;

^§ USG positivity = Ultrasonographic features include diffuse enlarged gland with irregular surface and ill-defined hypoechoic heterogeneous areas.

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