Effect of Thyroid Remnant Volume on the Risk of Hypothyroidism After Hemithyroidectomy: A Prospective Study

被引:38
作者
Lang, Brian Hung-Hin [1 ,4 ]
Wong, Carlos K. H. [2 ]
Wong, Kai Pun [1 ]
Chu, Kelvin Ka-Wan [1 ]
Shek, Tony W. H. [3 ]
机构
[1] Univ Hong Kong, Dept Surg, Hong Kong, Hong Kong, Peoples R China
[2] Univ Hong Kong, Dept Family Med & Primary Care, Hong Kong, Hong Kong, Peoples R China
[3] Univ Hong Kong, Dept Anat Pathol, Hong Kong, Hong Kong, Peoples R China
[4] Queen Mary Hosp, Div Endocrine Surg, Dept Surg, Hong Kong, Hong Kong, Peoples R China
关键词
ASSOCIATION GUIDELINES; IODINE INTAKE; MANAGEMENT; CANCER; ADULTS;
D O I
10.1245/s10434-016-5743-9
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Hypothyroidism is a common sequel after a hemithyroidectomy. Although various risk factors leading to hypothyroidism have been reported, the effect of the contralateral lobe's volume has been understudied. This study aimed to examine the association between the preoperative contralateral lobe's volume and the risk of postoperative hypothyroidism. During a 2-year period, 150 eligible patients undergoing a hemithyroidectomy were evaluated. The volume of the contralateral nonexcised lobe was estimated preoperatively by independent assessors on ultrasonography using the following formula: width (in cm) x depth (in cm) x length (in cm) x (pi/6), adjusted for the body surface area (BSA). Postoperative hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) exceeding 4.78 mIU/L. Any significant characteristics in the univariate analysis were entered into the multivariate analysis to determine independent factors. After a mean follow-up period of 53.5 +/- 9.4 months, 44 patients (29.3 %) experienced postoperative hypothyroidism, and 10 of these patients required thyroxine replacement. Hypothyroidism was associated with a higher preoperative TSH level (p < 0.001), a smaller BSA-adjusted volume (p < 0.001), fewer ipsilateral nodules (p = 0.037), and the presence of thyroiditis (p = 0.050). After adjustment for thyroiditis, preoperative TSH (p < 0.001), number of ipsilateral nodules (p = 0.048), and BSA-adjusted volume (p < 0.001) were independent factors for hypothyroidism. Patients with a BSA-adjusted volume smaller than 3.2 ml had a threefold greater hypothyroidism risk than those with a BSA-adjusted volume of 3.2 ml or more (p < 0.001). A significant inverse association between the preoperative contralateral lobe's volume and hypothyroidism risk was observed after hemithyroidectomy. Together with a higher preoperative TSH level and fewer ipsilateral nodules, a smaller BSA-adjusted volume measured by preoperative ultrasonography independently predicted hypothyroidism.
引用
收藏
页码:1525 / 1532
页数:8
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