Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy
Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy
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DOI：
10.1210/jc.2016-3597
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发表时间：
2017-04-01
影响因子：
5.8
通讯作者：
Kim, Won Gu
中科院分区：
文献类型：
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作者：
Park, Suyeon;Jeon, Min Ji;Kim, Won Gu
背景：甲状腺癌首选肺叶切除术，以减少手术并发症，避免终身甲状腺激素替代。然而，术后甲状腺功能减退症，需要甲状腺激素替代，可能happen.Objective：我们的目的是确定术后甲状腺功能减退症的发病率和危险因素，以制定一个监测策略后肺叶切除术乳头状甲状腺微小癌（PTMC）。术后定期测量甲状腺功能，并根据特定标准为患者开具左旋甲状腺素。结果：术后发生甲减215例（64.2%），其中显性甲减5例（1.5%），亚临床甲减210例（62.7%）。40例患者（11.9%）需要甲状腺激素替代治疗。119例患者（33.5%）发生暂时性甲状腺功能减退，并自发恢复至甲状腺功能正常状态。术前高促甲状腺激素（TSH）是预测术后甲减和甲减恢复失败的最重要因素（比值比[OR]分别为2.82和1.77; 95%可信区间[CI]分别为2.07 ~ 3.95和1.22 ~ 2.63; P < 0.001和0.002）。在215例最终发生术后甲状腺功能减退症的患者中，70例（32.6%）在术后第一年后发生甲状腺功能减退症。术后1年TSH水平可区分甲状腺功能正常或晚期甲减（OR，2.29; 95% CI，1.68 ~ 3.26; P < 0.001）。结论：术前和术后TSH水平可预测甲状腺功能减退症，并可鉴别需要长期监测的患者。此外，轻度术后甲状腺功能减退症病例应随访，无需立即使用左旋甲状腺素替代品，并期望自发恢复。
Context: Lobectomy is preferred in thyroid cancer to decrease surgical complications and avoid lifelong thyroid-hormone replacement. However, postoperative hypothyroidism, requiring thyroid-hormone replacement, may occur.Objective: We aimed to identify the incidence and risk factors of postoperative hypothyroidism to develop a surveillance strategy after lobectomy for papillary thyroid microcarcinoma (PTMC).Methods: This historical cohort study involved 335 patients with PTMC treated by lobectomy. Postoperative thyroid functions were measured regularly, and patients were prescribed levo-thyroxine according to specific criteria. Patients not satisfying hormone-replacement criteria were closely followed up.Results: Postoperative hypothyroidism occurred in 215 patients (64.2%) including 5 (1.5%) with overt hypothyroidism and 210 (62.7%) with subclinical hypothyroidism. Forty patients (11.9%) were required thyroid hormone replacement. One hundred nineteen patients (33.5%) experienced temporary hypothyroidism and spontaneously recovered to euthyroid state. High preoperative thyroid-stimulating hormone (TSH) was the most important factor predicting postoperative hypothyroidism and failure of recover from hypothyroidism (odds ratio [OR], 2.82 and 1.77; 95% confidence interval [CI], 2.07 to 3.95 and 1.22 to 2.63; P < 0.001 and 0.002, respectively). Of the 215 patients eventually developing postoperative hypothyroidism, 70 (32.6%) developed hypothyroidism after the first postoperative year. Postoperative 1-year TSH levels were able to differentiate patients developing late hypothyroidism or euthyroidism (OR, 2.29; 95% CI, 1.68 to 3.26; P < 0.001).Conclusions: Preoperative and postoperative TSH levels might be predictive for patients who develop postlobectomy hypothyroidism and identify those requiring long-term surveillance for hypothyroidism. Additionally, mild postoperative hypothyroidism cases should be followed up without immediate levothyroxine replacement with the expectation of spontaneous recovery.