Post-hemithyroidectomy hypothyroidism in non autoimmune thyroiditis patients: Incidence, risk factors and duration of follow up
Post-hemithyroidectomy hypothyroidism in non autoimmune thyroiditis patients: Incidence, risk factors and duration of follow up
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DOI：
10.1016/j.asjsur.2019.01.015
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发表时间：
2019-11-01
影响因子：
3.5
通讯作者：
Huang, Shih-Ming
中科院分区：
文献类型：
--
作者：
Chong, Shun-Siang;Hoh, Siew-Yep;Huang, Shih-Ming
背景：半甲状腺切除术有一个已知的，但难以预测的甲状腺功能减退症的后遗症。存在抗甲状腺抗体是已知的、经过充分研究的风险因素。其他假设的风险因素包括术前较高的TSH水平和术后甲状腺残留与患者体重的比值较低。我们回顾了我们的数据，以解决上述风险因素。方法：这是一项回顾性研究，在国立成功大学医院，台湾从2015年至2017年。125例患者接受了单侧甲状腺切除术，但24例患者因自身免疫性甲状腺炎而被排除，这被确定为排除标准。在手术前后的每次门诊访视中进行标准的血液检查。术后2个月进行颈部超声检查，以评估甲状腺残留。分类资料分析采用卡方检验。独立学生t检验用于参数分布的连续数据，Mann-Whitney U检验用于非参数数据。结果：平均随访时间29.3个月。101例患者中有4例发生临床甲状腺功能减退症; 23例患者在半甲状腺切除术后发生亚临床甲状腺功能减退症。6例亚临床甲减患者在1年内自行恢复。术前TSH >2.0 uIU/mL是一个危险因素，卡方检验显示p < 0.001。Mann-Whitney U检验P = 0.928，未发现甲状腺残留是甲状腺功能减退的危险因素。结论：建议对单侧甲状腺切除术患者至少随访1年，以免漏诊术后发生甲状腺功能减退的患者。(C)2019年亚洲外科协会和台湾机器人外科协会。出版社：Elsevier B. V.
Background: Hemithyroidectomy has a known but less predictable sequelae of hypothyroidism. Presence of anti-thyroid antibody is known, well studied risk factor. Other postulated risk factors include higher pre-operative TSH level and lower ratio of post-operative thyroid remnant to the patient's weight. We reviewed our data to address the above mentioned risk factors.Method: This was a retrospective study done in National Cheng Kung University Hospital, Taiwan from 2015 to 2017. 125 patients underwent hemithyroidectomy, but 24 patients were excluded due to autoimmune thyroiditis, which was determined as the exclusion criteria. Standard panel of blood investigations were taken in each clinic visit before and after operation. A neck ultrasound was done 2 months post-operatively to assess the thyroid remnant. Chi-square test was used for categorical data analysis. Independent student t-test was used for continuous data with parametric distribution and Mann-Whitney U test for non parametric data. p < 0.05 was taken as statistically significant.Result: The mean duration of follow up was 29.3 months. 4 out of 101 patients had clinical hypothyroidism; 23 patients developed subclinical hypothyroidism post-hemithyroidectomy. 6 patients of subclinical hypothyroidism had spontaneously recovered within 1 year. Pre-operative TSH >2.0 uIU/mL was a risk factor as Chi square test showed p < 0.001. However, thyroid remnants were found not to be a risk factor with the Mann-Whitney U test of p = 0.928.Conclusion: Minimum 1 year of follow up for hemithyroidectomy patients was suggested in order not to miss patients developing hypothyroidism post-operatively. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.