Hormonal Outcomes Following Hemithyroidectomy. (3rd November 2020)

• Record Type: Journal Article
• Authors: Buehler, Lauren Anne; Madhun, Nabil Zuhayr; Bena, James; Nasr, Christian; Scharpf, Joseph; Zhou, Keren
• Is Part Of: Otolaryngology--head and neck surgery. Volume 164:Number 5(2021)
• Page Start: 1011
• Page End: 1018
• Publication Date: 2020-11-03
• Subjects: hemithyroidectomy -- hormone replacement -- hormonal outcomes; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820962486
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: To assess hormonal outcomes and thyroid hormone (TH) replacement after hemithyroidectomy (HT). Study Design: Retrospective chart review. Setting: Quaternary care hospital system. Methods: A retrospective analysis was performed on patients who had an HT at Cleveland Clinic between 2000 and 2010 with outcomes assessed up to 5 years post‐HT. Patients with overt hypothyroidism (OH; thyroid‐stimulating hormone [TSH] >10 mIU/L, TSH >4.2 mIU/L on thyroid hormone [TH]), subclinical hypothyroidism (SH; TSH >4.2‐10 mIU/L, no TH), or euthyroidism (EU; TSH 0.4‐4.2 mIU/L, no TH) were compared. Patients with SH who returned to EU were compared to those who continued to have SH. For immediate start on TH, a receiver operating characteristic analysis was performed to determine dosage of TH above which suppression of TSH <0.4 mIU/L was predicted. Results: We identified 335 patients (average age 51 years, 78% female, median follow‐up of 50 months). Of the 210 not immediately started on TH, 32.4% were OH, 13.3% were SH, and 54.3% were EU. EU patients were younger (48 years), had more remaining gland, were less likely to have lymphocytic infiltrate, and had a lower preoperative TSH (1.2 mIU/L). In the SH group, 58.3% of patients normalized their TSH. With immediate TH start, 45% developed suppressed TSH. Those on LT4 >1.05 mcg/kg/d were more likely to suppress (sensitivity 89%). Conclusion: Most patients post‐HT will remain EU, and immediate start of TH may lead to TSH suppression. Those with SH may ultimately normalize TSH. These findings together suggest that observation may be a better option than TH replacement after HT.