Clinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics.

TitleClinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics.
Publication TypeJournal Article
Year of Publication2021
AuthorsBaran J, Bauer AJ, Halada SJ, Mostoufi-Moab S, Isaza A, Robbins SL, Franco A, N Adzick S, Patel T, Kazahaya K
JournalThyroid
Date Published2021 Oct 29
ISSN1557-9077
Abstract

INTRODUCTION: Thyroid lobectomy reduces risks of surgical complications and need for levothyroxine (LT4). We aimed to identify the clinical course and risk factors for post-lobectomy hypothyroidism to optimize surgical counseling and management in pediatric patients undergoing lobectomy.

METHODS: Clinical and biochemical presentations pre- and post-lobectomy 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 post-lobectomy hypothyroidism defined by an elevated thyroid stimulating hormone (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 post-lobectomy. When excluding patients with autonomous nodule(s), median preoperative TSH was 1.09 (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 post-lobectomy hypothyroidism (OR = 1.8; 95% CI = 1.08-3.13; p = 0.024). Of the patients who underwent thyroid lobectomy and developed post-operative hypothyroidism (n = 31), 38.7% (12/31) had a pre-operative diagnosis of an autonomous thyroid nodule.

CONCLUSIONS: Thyroid function should be evaluated post-lobectomy 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 nodule(s) is an independent risk factor for post-lobectomy hypothyroidism.

DOI10.1089/thy.2021.0396
Alternate JournalThyroid
PubMed ID34714171