Risk Factors for Hypothyroidism after Thyroid Lobectomy with Papillary Thyroid Crcinoma according to Existence of Thyroiditis

Hye-seung Shin M.D.; Jun-Wan Ko M.D.; Jun-Sik Kim M.D.; Duk-Jin Moon M.D.

doi:10.16956/kjes.2011.11.2.90

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M.D., M.D., M.D., and M.D.: Risk Factors for Hypothyroidism after Thyroid Lobectomy with Papillary Thyroid Crcinoma according to Existence of Thyroiditis

Review Article

Korean J Endocrine Surg 2011;11(2):90-96.

Published online: 18 June 2011

DOI: https://doi.org/10.16956/kjes.2011.11.2.90

Risk Factors for Hypothyroidism after Thyroid Lobectomy with Papillary Thyroid Crcinoma according to Existence of Thyroiditis

Hye-seung Shin M.D., Jun-Wan Ko M.D., Jun-Sik Kim M.D., Duk-Jin Moon M.D.

Department of Surgery, Kwangju Christian Hospital, Gwangju, 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:

This study evaluated the risk factors for hypothyroidism after lobectomy for low risk papillary thyroid carcinoma according to existence of thyroiditis, especially on preoperative thyroid stimulating hormone (TSH) level and remnant thyroid volume.

Methods:

The clinical records of 169 patients who underwent thyroid lobectomy due to papillary thyroid carcinoma were reviewed. We maintain the TSH level between 0.10∼ 0.50 mU/L with thyroid hormone until 6 to 12 months after lobectomy. Then we stopped medication and check TSH level at intervals of 2∼6 months. The patients were divided into 2 groups; hypothyroid (n=63) and euthyroid (n=106) state after lobectomy. Euthyroid state was defined as an TSH level between 0.50∼5.0 mU/L, hypothyroid state as an elevated TSH level above 10 mU/L and need thyroid hormone.

Results:

Factor for age, sex, type of operation, result of biopsy were not significant to postoperative hypothyroidism. Presence of thyroid autoantibody was significantly different (P＜0.01) in the patients with thyroiditis compared with the patients without thyroiditis. When patient had thyroiditis, there was high possibility of postoperative hypothyroidism regardless of preoperative TSH level and remnant thyroid volume (P＞0.05). When patient didn't have thyroiditis, there was high possibility of postoperative hypothyroidism when preoperative TSH is in high normal level and remnant thyroid volume ratio is below 50% (P＜0.01).

Conclusion:

One can check the presence of thyroiditis with thyroid autoantibody and can predict the possibility of postoperative hypothyroidism after lobectomy in patients with low risk papillary thyroid carcinoma with preoperative TSH level and remnant thyroid volume.

Keywords: Thyroid cancer, Thyroidectomy, Thyroiditis, Hypothyroidism

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Table 1.

General characteristics of the patients

	Hypothyroid (n=63)	Euthyroid (n=106)	P value
Median age (range) (year)	44.2 (25∼55)	42.1 (28∼59)	0.64
Gender (M : F)	1 : 4.25	1 : 4.04	0.90
Male	12 (19%)	21 (20%)
Female	51 (81%)	85 (80%)
Type of operation			0.86
Lobectomy	12 (19%)	33 (31%)
Lobectomy＋Isthmectomy	51 (81%)	73 (69%)
Capsular invasion∗			0.57
Yes	7 (11%)	9 (8%)
No	56 (89%)	97 (92%)
Nodal status^†			0.99
N0	57 (90%)	96 (91%)
N1a	6 (10%)	10 (9%)
Thyroiditis			＜0.01
Yes	26 (41%)	5 (5%)
No	37 (59%)	101 (95%)
Preoperative TSH
Median (range) (mU/L)	3.64 (2.05∼4.79)	2.56 (0.63∼3.45)	＜0.01
0.5≤TSH＜3.0 (mU/L)	19 (30%)	94 (89%)	＜0.01
3.0≤TSH≤5.0 (mU/L)	44 (70%)	12 (11%)
Thyroid autoantibody			＜0.01
Positive	25 (40%)	14 (13%)
Negative	38 (60%)	92 (87%)
Median total thyroid volume (range) (cm³)	41.71 (16.74∼72.88)	43.02 (16.25∼76.98)	0.64
Median remnant thyroid volume (range) (cm³)	18.77 (8.33∼34.55)	24.09 (9.75∼51.44)	＜0.01
Volume ratio between total thyroid andremnant thyroid
Median (range) (%)	45 (43∼52)	56 (45∼60)	＜0.01
＜50%	39 (62%)	17 (16%)	＜0.01
≥50%	24 (38%)	89 (84%)

^∗ Tumor size was ＜1 cm in all cases;

^† Only ipsilateral level VI lymph node dissection was done.

Table 2.

Thyroid autoantibody and thyroiditis

Thyroid autoantibody	Thyroiditis (n=31)	Non-thyroiditis (n=138)	P value
Positive	26 (84%)	13 (9%)	＜0.01
Negative	5 (16%)	125 (91%)

Table 3.

Patients with thyroiditis

	Hypothyroid (n=26)	Euthyroid (n=5)	P value
Median age (range) (year)	43.7 (25∼55)	40.1 (28∼54)	0.73
Gender (M：F)	1：4.2	1：4.0	0.69
Male	5 (19%)	1 (20%)
Female	21 (81%)	4 (80%)
Type of operation			0.58
Lobectomy	6 (23%)	2 (40%)
Lobectomy＋Isthmectomy	20 (77%)	3 (60%)
Capsular invasion∗			0.61
Yes	4 (15%)	1 (20%)
No Nodal status^†	22 (85%)	4 (80%)	0.58
N0	20 (77%)	3 (60%)
N1a	6 (23%)	2 (40%)
Preoperative TSH
Median (range) (mU/L)	3.99 (2.06∼4.79)	3.44 (2.34∼4.51)	0.71
0.5≤TSH＜3.0 (mU/L)	5 (19%)	3 (60%)	0.09
3.0≤TSH≤5.0 (mU/L)	21 (81%)	2 (40%)
Thyroid autoantibody			0.42
Positive	22 (85%)	4 (80%)
Negative	4 (15%)	1 (20%)
Median total thyroid volume (range) (cm³)	61.34 (49.80∼72.88)	62.88 (52.78∼76.98)	0.69
Median remnant thyroid volume (range) (cm³)	29.44 (23.61∼34.55)	32.70 (28.76∼51.14)	0.31
Volume ratio between total thyroid and remnant thyroid
Median (range) (%)	48 (44∼52)	52 (45∼53)	0.26
＜50%	14 (54%)	2 (40%)	0.65
≥50%	12 (46%)	3 (60%)

^∗ Tumor size was ＜1 cm in all cases;

^† Only ipsilateral level VI lymph node dissection was done.

Table 4.

Patients without thyroiditis

	Hypothyroid (n=37)	Euthyroid (n=101)	P value
Median age (range) (year)	44.8 (30∼55)	43.4 (37∼59)	0.61
Gender (M : F)	1 : 4.3	1 : 4.0	0.90
Male	7 (19%)	20 (20%)
Female	30 (81%)	81 (80%)
Type of operation			0.89
Lobectomy	6 (16%)	31 (31%)
Lobectomy＋Isthmectomy	31 (84%)	70 (69%)
Capsular invasion∗			0.97
Yes	3 (8%)	8 (8%)
No	34 (92%)	93 (92%)
Nodal status^†			0.46
N0	30 (81%)	87 (86%)
N1a	7 (19%)	14 (14%)
Preoperative TSH
Median (range) (mU/L)	3.31 (2.05∼4.17)	1.69 (0.63∼3.45)	＜0.01
0.5≤TSH＜3.0 (mU/L)	14 (38%)	91 (90%)	＜0.01
3.0≤TSH≤5.0 (mU/L)	23 (62%)	10 (10%)
Thyroid autoantibody			0.75
Positive	3 (8%)	10 (10%)
Negative	34 (92%)	91 (90%)
Median total thyroid volume (range) (cm³)	22.08 (16.74∼27.42)	21.15 (16.25∼26.05)	0.61
Median remnant thyroid volume (range) (cm³)	10.15 (8.33∼13.45)	12.27 (9.75∼15.17)	＜0.01
Volume ratio between total thyroid and remnant thyroid
Median (range) (%)	46 (43∼52)	58 (48∼60)	＜0.01
＜50%	13 (35%)	15 (15%)	＜0.01
≥50%	24 (65%)	86 (85%)

^∗ Tumor size was ＜1 cm in all cases;

^† Only ipsilateral level VI lymph node dissection was done.

Table 5.

Multivariate analysis in patients without thyroiditis

	Odds ratio	P value
TSH level	1.56	＜0.01
Volume ratio	3.10	＜0.01

Table 6.

Clinical hypothyroidism: time to diagnosis (median time (range): 11.6 (4∼24) months)

Time to diagnosis	Clinical hypothyroidism (n=63) (%)
2 months	0 (0%)
4 months	1 (2%)
6 months	2 (3%)
9 months	24 (38%)
12 months	26 (41%)
18 months	8 (13%)
24 months	2 (3%)

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