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Abstract
Purpose:
Thyroid lobectomy is one of the common operative procedures in patients with benign thyroid nodules. The procedure is relatively feasible, but some patients who receive lobectomies have the complications, such as nerve injury, hypocalcemia, and hypothyroidism. We examined the frequency of hypothyroidism and predictable factor following thyroid lobectomy due to benign thyroid nodules.
Methods:
Retrospective analysis was carried out on 212 patients who underwent thyroid lobectomy to benign nodules from January 2005 to May 2010. The risk factors, including sex, age at diagnosis, thyroid function test results, existence of thyroiditis, thyroid volume, and results of the pre-and post-operation thyroid ultrasounds, were analyzed between euthyroidism and hypothyroidism groups.
Results:
The rate of hypothyroidism was 17%. In the univariate analysis, age, multiplicity of nodules, thyroiditis, preoperative levels of Tg and TSH, and thyroid volume were significantly predictable factors of hypothyroidism. In the multivariate analysis, the significant factors associated with hypothyroidism were being over 40 years old, having a preoperative TSH of more than 2 mlU/L, and having a small thyroid volume.
Conclusion:
Hypothyroidism following lobectomy is not dis-asterous complication. We should discuss the possibility of postoperative hypothyroidism carefully with patients before operation, especially when we plan to perform lobectomy on the patients who are over 40, have high TSH levels before surgery, or have a small thyroid volume.
REFERENCES
1.Singer PA., Cooper DS., Daniels GH., Ladenson PW., Greenspan FS., Levy EG, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med. 1996. 156:2165–72.
2.Wong CK., Wheeler MH. Thyroid nodules: rational management. World J Surg. 2000. 24:934–41.
3.Hegedüs L., Bonnema SJ., Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003. 24:102–32.
4.Cooper DS., Doherty GM., Haugen BR., Kloos RT., Lee SL., Mandel SJ, et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009. 19:1167–214.
5.Phitayakorn R., McHenry CR. Follow-up after surgery for benign nodular thyroid disease: evidence-based approach. World J Surg. 2008. 32:1374–84.
6.Bahn RS., Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab. 2011. 96:1202–12.
7.McHenry CR., Slusarczyk SJ. Hypothyroidisim following hemithyroidectomy: incidence, risk factors, and management. Surgery. 2000. 128:994–8.
8.Miller FR., Paulson D., Prihoda TJ., Otto RA. Risk factors for the development of hypothyroidism after hemithyroidectomy. Arch Otolaryngol Head Neck Surg. 2006. 132:36–8.
9.Moon HG., Jung EJ., Park ST., Jung TS., Jeong CY., Ju YT, et al. Thyrotropin level and thyroid volume for prediction of hypothyroidism following hemithyroidectomy in an Asian patient cohort. World J Surg. 2008. 32:2503–8.
10.Tunbridge WM., Evered DC., Hall R., Appleton D., Brewis M., Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977. 7:481–93.
11.Vander JB., Gaston EA., Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1968. 69:537–40.
12.Tan GH., Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997. 126:226–31.
13.Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004. 351:1764–71.
14.Mandel SJ. A 64-year-old woman with a thyroid nodule. JAMA. 2004. 292:2632–42.
15.Yetkin G., Uludag M., Onceken O., Citgez B., Isgor A., Akgun I. Does unilateral lobectomy suffice to manage unilateral nontoxic goiter? Endocr Pract. 2010. 16:36–41.
16.Costanzo M., Caruso LA., Messina DC., Cavallaro A., Palumbo A., Cannizzaro MA. Benign thyroid nodule: what is the treatment? Personal experience. Ann Ital Chir. 2005. 76:9–12.
17.Raval MV., Browne M., Chin AC., Zimmerman D., Angelos P., Reynolds M. Total thyroidectomy for benign disease in the pediatric patient–feasible and safe. J Pediatr Surg. 2009. 44:1529–33.
18.Delbridge L. Total thyroidectomy: the evolution of surgical technique. ANZ J Surg. 2003. 73:761–8.
19.Dener C. Complication rates after operations for benign thyroid disease. Acta Otolaryngol. 2002. 122:679–83.
20.Su SY., Grodski S., Serpell JW. Hypothyroidism following hemithyroidectomy: a retrospective review. Ann Surg. 2009. 250:991–4.
21.Berglund J., Bondesson L., Christensen SB., Larsson AS., Tibblin S. Indications for thyroxine therapy after surgery for nontoxic benign goitre. Acta Chir Scand. 1990. 156:433–8.
22.Piper HG., Bugis SP., Wilkins GE., Walker BA., Wiseman S., Baliski CR. Detecting and defining hypothyroidism after hemithyroidectomy. Am J Surg. 2005. 189:587–91.
23.Shin HS., Ko JW., Kim JS., Moon DJ. Risk factors for hypothyroidism after thyroid lobectomy with papillary thyroid crcinoma according to existence of thyroiditis. Korean J Endocrine Surg. 2011. 11:90–6.
24.Buchanan MA., Lee D. Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre. J R Coll Surg Edinb. 2001. 46:86–90.
25.Piper HG., Bugis SP., Wilkins GE., Walker BA., Wiseman S., Baliski CR. Detecting and defining hypothyroidism after hemithyroidectomy. Am J Surg. 2005. 189:587–91.
26.Baloch Z., Carayon P., Conte-Devolx B., Demers LM., Feldt-Rasmussen U., Henry JF, et al. Guidelines Committee, National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003. 13:3–126.
Table 1.
Univariate analysis between euthyroidism and hypothy roidism goups
Table 2.
Multivariate analysis of factors associated with hypothyroidism following to thyroid lobectomy
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