Clinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics.
Clinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics.
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儿科甲状腺叶切除术后早期甲状腺功能减退症的临床过程。
DOI：
10.1089/thy.2021.0396
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Kazahaya,Ken
中科院分区：
文献类型：
--
作者：
Baran,JuliaA;Bauer,AndrewJ;Halada,Stephen;Mostoufi-Moab,Sogol;Isaza,Amber;Robbins,Stephanie;Franco,AimeT;Adzick,NScott;Patel,Tasleema;Kazahaya,Ken
引言：甲状腺叶切除术降低了手术并发症的风险和对左旋甲状腺素（LT 4）的需求。我们的目的是确定甲状腺叶切除术后甲状腺功能减退症的临床过程和危险因素，以优化接受甲状腺叶切除术的儿科患者的手术咨询和管理。方法：回顾性分析了2008年至2020年期间在费城儿童医院接受甲状腺叶切除术的110例患者的临床和生化表现。结果：大约28.2%的患者（31/110）发生了由促甲状腺激素（TSH）水平升高定义的肺叶切除术后甲状腺功能减退症，其中亚临床甲减（TSH >4.5且<10.0mIU/L）占24.5%（27/110），显性甲减（TSH > 10.0mIU/L）占3.6%（4/110）。在12.7%（14/110）的病例中启动了LT 4。大多数患者（81.6%; 84/103）在肺叶切除术后12个月内恢复甲状腺功能正常。排除自主性结节患者后，术前TSH中位数为1.09（四分位距[IQR] = 0.70-1.77）mIU/L和1.80（IQR = 1.02-2.68）mIU/L（甲状腺功能正常和甲状腺功能减退患者），多因素Logistic回归证实术前TSH升高与肺叶切除术后甲状腺功能减退症之间的相关性（比值比= 1.8 [置信区间1.08-3.13]，p= 0.024）。接受甲状腺叶切除术和术后甲状腺功能减退症的患者（n= 31），38.7%（12/31）有一个自主功能的甲状腺nodel.Conclusions术前诊断：甲状腺功能应进行评估后叶切除术，以评估需要LT 4。如果TSH仍然升高，特别是如果观察到上升趋势或TSH>10.0 mIU/L，应考虑LT 4。与自主结节相关的术前TSH抑制是肺叶切除术后甲状腺功能减退症的独立危险因素。
Introduction:Thyroid lobectomy reduces risks of surgical complications and need for levothyroxine (LT4). We aimed at identifying the clinical course and risk factors for postlobectomy hypothyroidism to optimize surgical counseling and management in pediatric patients undergoing lobectomy.Methods:Clinical and biochemical presentations pre- and postlobectomy were retrospectively reviewed for 110 patients who underwent thyroid lobectomy between 2008 and 2020 at the Children's Hospital of Philadelphia.Results:Approximately 28.2% of patients (31/110) developed postlobectomy hypothyroidism defined by an elevated thyrotropin (TSH) level, including 24.5% (27/110) with subclinical hypothyroidism (TSH >4.5 and <10.0 mIU/L) and 3.6% (4/110) with overt hypothyroidism (TSH >10.0 mIU/L). LT4 was initiated in 12.7% (14/110) of cases. Most patients (81.6%; 84/103) recovered euthyroidism within 12 months postlobectomy. When excluding patients with autonomous nodule(s), median preoperative TSH was 1.09 (interquartile range [IQR] = 0.70–1.77) mIU/L and 1.80 (IQR = 1.02–2.68) mIU/L in euthyroid and hypothyroid patients, respectively, with multivariate logistic regression confirming the association between an increased preoperative TSH and postlobectomy hypothyroidism (odds ratio = 1.8 [confidence interval 1.08–3.13],p= 0.024). Of the patients who underwent thyroid lobectomy and developed postoperative hypothyroidism (n= 31), 38.7% (12/31) had a preoperative diagnosis of an autonomously functioning thyroid nodule.Conclusions:Thyroid function should be evaluated postlobectomy to assess the need for LT4. LT4 should be considered if the TSH remains elevated, especially if an upward trend is observed or TSH is >10.0 mIU/L. Suppressed preoperative TSH associated with autonomous nodules is an independent risk factor for postlobectomy hypothyroidism.
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影响因子：
5.2
作者：
Dou Y;Chen Y;Hu D;Su X
通讯作者：
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影响因子：
5.2
作者：
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是时候重新考虑低风险儿科甲状腺癌的肺叶切除术了吗？
影响因子：
3.2
作者：
W. Kluijfhout;J. Pasternak;D. Kaay;M. Vriens;E. Propst;J. Wasserman
通讯作者：
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儿童和青少年良性结节性甲状腺疾病部分甲状腺切除术后结节复发和甲状腺功能减退。
影响因子：
1.5
作者：
M. Akkari;D. Schmitt;C. Jeandel;I. Raingeard;Catherine Blanchet;C. Cartier;R. Garrel;Bernard Guerrier;M. Makeieff;Michel Mondain
通讯作者：
Michel Mondain