Predictors Associated with the Maintenance of Normal Thyroid Function after Unilateral Total Thyroidectomy in Patients with Papillary Thyroid Microcarcinoma
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Purpose: The goal of this study was to identify factors affecting the maintenance of normal thyroid function in patients who did not receive immediate levothyroxine replacement after unilateral thyroid lobectomy (UTL) for papillary thyroid microcarcinoma (PTMC). Methods: A total of 232 patients were treated for PTMC between January 2015 and December 2017, of whom 40 patients were excluded because of treatment for thyroid disease (n=22) or an inability to maintain normal thyroid function during the preoperative examination (n=18). The remaining 192 patients for whom normal follow-up investigation was possible were then retrospectively analyzed for parameters including sex, age, preoperative free T4, thyroid-stimulating hormone (TSH), thyroglobulin, thyroid autoantibody, body mass index, postoperative histology, and remnant thyroid gland volume. Results: Of the 192 patients included in this study, 97 (50.5%) maintained normal thyroid function without levothyroxine replacement after UTL. The remaining 95 (49.5%) patients developed postoperative hypothyroidism, which was treated with immediate hormonal intervention. Univariate factors associated with postoperative hypothyroidism included sex, postoperative histopathology of the thyroid gland, and the preoperative TSH level. In the multivariate analysis, sex and preoperative TSH levels were identified as significant factors. Conclusion: Female sex and increasing preoperative TSH levels were identified as independent predictors of the development of postoperative hypothyroidism. The cut-off preoperative TSH level for predicting the maintenance of normal thyroid function after UTL was 1.89 mIU/L. Based on these observations, the potential risk of postoperative hypothyroidism in patients exhibiting elevated TSH levels should be discussed before initiating surgery.
Abstract
Purpose: The goal of this study was to identify factors affecting the maintenance of normal thyroid function in patients who did not receive immediate levothyroxine replacement after unilateral thyroid lobectomy (UTL) for papillary thyroid microcarcinoma (PTMC). Methods: A total of 232 patients were treated for PTMC between January 2015 and December 2017, of whom 40 patients were excluded because of treatment for thyroid disease (n=22) or an inability to maintain normal thyroid function during the preoperative examination (n=18). The remaining 192 patients for whom normal follow-up investigation was possible were then retrospectively analyzed for parameters including sex, age, preoperative free T4, thyroid-stimulating hormone (TSH), thyroglobulin, thyroid autoantibody, body mass index, postoperative histology, and remnant thyroid gland volume. Results: Of the 192 patients included in this study, 97 (50.5%) maintained normal thyroid function without levothyroxine replacement after UTL. The remaining 95 (49.5%) patients developed postoperative hypothyroidism, which was treated with immediate hormonal intervention. Univariate factors associated with postoperative hypothyroidism included sex, postoperative histopathology of the thyroid gland, and the preoperative TSH level. In the multivariate analysis, sex and preoperative TSH levels were identified as significant factors. Conclusion: Female sex and increasing preoperative TSH levels were identified as independent predictors of the development of postoperative hypothyroidism. The cut-off preoperative TSH level for predicting the maintenance of normal thyroid function after UTL was 1.89 mIU/L. Based on these observations, the potential risk of postoperative hypothyroidism in patients exhibiting elevated TSH levels should be discussed before initiating surgery.
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