Clinicopathologic predictors for early and late biochemical hypothyroidism after hemithyroidectomy
Clinicopathologic predictors for early and late biochemical hypothyroidism after hemithyroidectomy
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DOI：
10.1016/j.amjsurg.2011.03.004
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发表时间：
2012-04-01
影响因子：
3
通讯作者：
Lang, Brian Hung-Hin
中科院分区：
文献类型：
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作者：
Chu, Kevin Ka-Wan;Lang, Brian Hung-Hin
背景：甲状腺切除术后生化性甲状腺功能减退（BH）是一种未被充分认识的并发症，据报道发病率为9%至43%。本研究旨在确定与早期（甲状腺切除术后12个月）BH相关的潜在临床病理危险因素。方法：2005年至2008年对263例术后患者进行分析。术后定期检查血清促甲状腺激素（TSH）水平。术后TSH高于5.5 mIU/L定义为BH。总中位随访期为21个月（范围3-62个月）。将单因素分析中与BH有显著相关性的临床病理因素纳入多因素分析。进一步分析比较早发性和晚发性BH的因素。结果：38例患者发生后发BH，其中33例在2年内发生。与非BH患者相比，BH患者年龄更大（P = 0.037），术前TSH水平更高（P < 0.001），随访时间更长（P < 0.001），组织学上甲状腺炎更常见（P = 0.043），切除组织重量更轻（P = 0.001），抗微粒体抗体阳性（P = 0.043）的可能性更大。然而，在调整两组不同随访期后的多因素分析中，只有较轻的切除组织重量（P = 0.036）和组织学上合并甲状腺炎（P = 0.005）被认为是BH的独立因素。组织学上的甲状腺炎也是发生早发性BH的唯一显著危险因素。结论：组织学上切除组织重量较轻且伴有甲状腺炎的患者发生BH的风险特别高。虽然不是所有甲状腺炎患者都会发展为BH，但在那些发展为BH的患者中，BH发生在前11个月内。(C) 2012爱思唯尔公司版权所有。
BACKGROUND: Biochemical hypothyroidism (BH) after hemithyroidectomy is an under-recognized complication with a reported incidence of 9% to 43%. This study aimed to identify potential clinicopathologic risk factors associated with early (= 12 months after hemithyroidectomy) BH.METHODS: From 2005 to 2008 there were 263 postsurgical patients who were eligible for analysis. Serum thyroid stimulating hormone (TSH) level was checked regularly after surgery. Postoperative TSH reaching a level higher than 5.5 mIU/L was defined as BH. The overall median follow-up period was 21 months (range, 3-62 mo). Any clinicopathologic factors significantly associated with BH in the univariate analysis were entered into multivariate analysis. A further analysis was performed comparing factors between early and late-onset BH.RESULTS: There were 38 patients who developed subsequent BH, 33 of these cases developed within 2 years. Those patients with BH were significantly older (P = .037), had a higher preoperative TSH level (P < .001), longer follow-up period (P < .001), more frequent thyroiditis on histology (P = .043), lighter resected tissue weight (P = .001), and were more likely to have positive antimicrosomal antibodies (P = .043) than those without BH. However, in the multivariate analysis after adjusting for different follow-up periods in the 2 groups, only lighter resected tissue weight (P = .036) and concomitant thyroiditis on histology (P = .005) turned out to be independent factors for BH. Thyroiditis on histology was also the only significant risk factor for developing early onset BH.CONCLUSIONS: Patients with lighter resected tissue weight and concomitant thyroiditis on histology were particularly at risk for subsequent BH. Although not all patients with thyroiditis developed BH, in those who did develop BH it occurred within the first 11 months. (C) 2012 Elsevier Inc. All rights reserved.