2015 American Thyroid Association guidelines and thyroid‐stimulating hormone suppression after thyroid lobectomy. Issue 2 (30th October 2020)

• Record Type: Journal Article
• Authors: Reed, Robert; Strumpf, Andrew; Martz, Teresa G.; Kavanagh, Kaitlin J.; Fedder, Katherine L.; Jameson, Mark J.; Shonka, David C.
• Is Part Of: Head & neck. Volume 43:Issue 2(2021)
• Page Start: 639
• Page End: 644
• Publication Date: 2020-10-30
• Subjects: differentiated thyroid cancer -- levothyroxine -- lobectomy -- synthroid -- TSH suppression; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.26524
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: 2015 American Thyroid Association (ATA) guidelines recommended more conservative treatment in low‐risk well‐differentiated thyroid cancer (WDTC), stating that lobectomy alone may be sufficient. The guidelines further recommend mild thyroid‐stimulating hormone (TSH) level suppression (0.5‐2 mU/L) for this population. Our goal is to evaluate the natural history of patients undergoing lobectomy to determine the percentage that would require postoperative levothyroxine supplementation under these guidelines. Methods: Retrospective chart review of 168 patients that underwent lobectomy between 2010 and 2019 was performed. Preoperative and postoperative TSH values and the rate of patients prescribed levothyroxine were analyzed. Results: Thirty‐five percent of patients were prescribed levothyroxine postoperatively. At 6 weeks postoperatively, 66% had TSH value of >2; this increased to 76% by 6 to 12 months. Conclusion: To adhere to ATA guidelines for WDTC managed with lobectomy alone, the majority of patients (76%) would require postoperative levothyroxine supplementation. Low preoperative TSH was found to be the most significant predictor for postoperative TSH < 2.