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Banyi N, Kwon JJY, Turkdogan S, Milner TD, Prisman E. Incidence and complications of hypothyroidism postlaryngectomy: A systematic review and meta-analysis. Head Neck 2024; 46:249-261. [PMID: 37950641 DOI: 10.1002/hed.27573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Hypothyroidism is common postlaryngectomy and is associated with laryngectomy-specific complications. The objective of this study is to determine the incidence and predictors of hypothyroidism postlaryngectomy and its associated complications. METHODS Systematic review, data extraction, and meta-analyses were performed following the PRISMA protocol. Six databases were searched for studies reporting on postlaryngectomy thyroid status with incidence, risk factors, management, or complications. RESULTS Fifty-one studies with 6333 patients were included. The pooled incidence of postlaryngectomy hypothyroidism is 49% (CI 42%-57%). Subgroup analysis showed postlaryngectomy hypothyroidism rates significantly correlated with hemithyroidectomy and radiotherapy. Patients who underwent laryngectomy, hemithyroidectomy, and radiotherapy had a 65% (CI 59%-71%) rate of hypothyroidism; laryngectomy and hemithyroidectomy 46% (CI 33%-60%); laryngectomy and radiotherapy 26% (CI 19%-35%); and laryngectomy alone 11% (CI 4%-27%) (p < 0.001). CONCLUSIONS Laryngectomized patients with partial thyroidectomy or radiation therapy are at significant risk of postoperative hypothyroidism. Evidence-based protocols for early detection and (prophylactic) treatment should be established.
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Affiliation(s)
- Norbert Banyi
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie J Y Kwon
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sena Turkdogan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Thomas D Milner
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Noy R, Habashi N, Akrish S, Cohen J, Shkedy Y. Preoperative tracheostomy is associated with thyroid gland invasion and poorer prognosis in laryngectomized patients. Eur Arch Otorhinolaryngol 2024; 281:935-943. [PMID: 37880425 DOI: 10.1007/s00405-023-08302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. METHODS All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator. RESULTS A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03). CONCLUSION Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ELS. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond) 2022; 74:103309. [PMID: 35145675 PMCID: PMC8818527 DOI: 10.1016/j.amsu.2022.103309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methods This study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. Results There was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. Conclusion The incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control. Thyroid gland invasion incidence in advanced laryngeal carcinoma is low. Thyroid gland Preservation during laryngectomy does not affect the oncological control. There was no statistically significant difference between the thyroid sparing and thyroid sacrificing group regarding the incidence of recurrence. Due toding author”. Due toding author".
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Li Qian L, Hopkins ME, Nixon IJ, Hay A. Thyroid function post laryngectomy and hemithyroidectomy - Do all laryngectomy patients need thyroid replacement? Clin Otolaryngol 2021; 47:323-327. [PMID: 34698445 DOI: 10.1111/coa.13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 07/30/2021] [Accepted: 10/10/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Lucy Li Qian
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | | | - Iain James Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Ashley Hay
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
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5
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Does thyroid-sparing total laryngectomy decrease the risk of hypothyroidism? The Journal of Laryngology & Otology 2020; 134:1069-1072. [PMID: 33243316 DOI: 10.1017/s0022215120002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network ('NCCN') guidelines. However, it is associated with a 32-89 per cent risk of hypothyroidism, with or without adjuvant radiotherapy. OBJECTIVE The study aimed to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of total laryngectomy. METHOD A retrospective study was conducted at Groote Schuur Hospital in Cape Town, South Africa. RESULTS Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2 per cent. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid-sparing total laryngectomy compared to hemithyroidectomy (p = 0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p = 0.001). CONCLUSION Thyroid-preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma, as it reduces the incidence of hypothyroidism.
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Baghel SS, Singhal P, Verma N, Sehra R, Yadav R, Agarwal S, Sharma MP, Gupta DP. Is thyroid excision mandatory with laryngectomy in carcinoma larynx? BMC Cancer 2020; 20:700. [PMID: 32723304 PMCID: PMC7389649 DOI: 10.1186/s12885-020-07205-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial. Methods A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx. Results 11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively. Conclusion Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.
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Affiliation(s)
- Surendra Singh Baghel
- Department of Neuro-otology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Pawan Singhal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India.
| | - Namita Verma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Ritu Sehra
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Rajeev Yadav
- Department of Preventive and Social Medicine, Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sunita Agarwal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Man Prakash Sharma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - D P Gupta
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
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Larbcharoensub N, Wattanatranon D, Leopairut J, Suntisuktana S, Roongpupaht B, Chintrakarn C, Tungkeeratichai J, Praneetvatakul P, Bhongmakapat T, Cheewaruangroj W, Prakunhungsit S. Clinicopathologic Findings and Treatment Outcome of Laryngectomized Patients with Laryngeal Cancer and Hypopharyngeal Cancer: An Experience in Thailand. Asian Pac J Cancer Prev 2017; 18:2035-2042. [PMID: 28843218 PMCID: PMC5697456 DOI: 10.22034/apjcp.2017.18.8.2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the clinicopathologic findings and treatment outcome in laryngectomized patients with laryngeal cancer and hypopharyngeal cancer. Materials and Methods: The authors retrospectively reviewed the medical records of 212 patients who had been newly diagnosed and treated with laryngectomy between January 2000 and December 2010. The age, gender, clinical manifestations, associated predisposing condition, tumor WHO grade, AJCC tumor stage, maximum tumor size, anatomical involvement, type of surgery, postoperative sequelae, treatment and therapeutic outcome were analyzed. Results: The present study included laryngeal cancer (n = 155) and hypopharyngeal cancer (n = 57). The patients’ age ranged from 38 to 84 years, with the mean age of 62.08±9.67 years. The common clinical presentations were hoarseness (73.6%), cervical lymphadenopathy (35.8%), sorethroat (22.2%), and odynophagia (14.6%). The laryngeal cancer commonly involves true vocal cord (86.5%), anterior commissure (65.8%), false vocal cord (56.8%), laryngeal ventricle (53.5%), subglottis (47.1%), and paraglotic space (35.5%), respectively. Fifty-three percent of cases had stage IV cancer. The most common postoperative surgical sequela was hypothyroidism (77.8%). The overall 5-year survivals for laryngeal cancer and hypopharyngeal cancer were 55% and 9%, respectively. The 5-year survival for node-negative cases was 61.8% versus 17% for node-positive cases (p< 0.001). AJCC stage of laryngeal cancer and hypopharyngeal cancer was a significant predictor of 5-year survival (p< 0.001 and p = 0.004, respectively). Conclusions: The advanced AJCC stage, advanced T stage, advanced N stage, extracapsular tumor spread, and tumor invasion of false vocal cord, epiglottis, preepiglottic space, paraglottic space, thyroid cartilage, cricothyroid membrane were found to significantly augment the decrease of 5-year survival in laryngeal cancer. Only advanced AJCC stage was significantly associated with 5-year survival rate in hypopharyngeal cancer.
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Affiliation(s)
- Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. E-mail:
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8
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Lin P, Huang X, Zheng C, Cai Q, Guan Z, Liang F, Zheng Y. The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2016; 274:361-366. [PMID: 27520569 DOI: 10.1007/s00405-016-4258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate the predictive value of magnetic resonance imaging (MRI) in detecting thyroid gland invasion (TGI) in patients with advanced laryngeal or hypopharyngeal carcinoma. In a retrospective chart review, 41 patients with advanced laryngeal or hypopharyngeal carcinoma underwent MRI scan before total laryngectomy and ipsilateral or bilateral thyroidectomy during the past 5 years. The MRI findings were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Among the 41 patients, 3 had thyroid gland invasion in postoperative pathological results. MRI correctly predicted the absence of TGI in 37 of 38 patients and TGI in all 3 patients. The sensitivity, specificity, PPV, and NPV of MRI were 100.0, 97.4, 75.0, and 100 %, respectively, with the diagnostic accuracy of 97.6 %. In consideration of the high negative predictive value of MRI, it may help surgeons selectively preserve thyroid gland in total laryngectomy and reduce the incidence of hypothyroidism and hypoparathyroidism postoperatively.
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Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Qian Cai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Zhong Guan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Yiqing Zheng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China.
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10
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Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study. The Journal of Laryngology & Otology 2016; 130:478-81. [PMID: 26975210 DOI: 10.1017/s0022215116000967] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients. METHODS Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma. RESULTS Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology). CONCLUSION Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).
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11
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Gorphe P, Ben Lakhdar A, Tao Y, Breuskin I, Janot F, Temam S. Evidence‐based management of the thyroid gland during a total laryngectomy. Laryngoscope 2015; 125:2317-22. [DOI: 10.1002/lary.25417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/10/2022]
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Pirola I, Daffini L, Gandossi E, Lombardi D, Formenti A, Castellano M, Cappelli C. Comparison between liquid and tablet levothyroxine formulations in patients treated through enteral feeding tube. J Endocrinol Invest 2014; 37:583-7. [PMID: 24789541 DOI: 10.1007/s40618-014-0082-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The majority of clinicians suggest that enteral feedings should be held 1-2 h prior to and after L-T4 administration despite lack of data for continuous enteral nutrition. AIM The aim of this study was to: (1) compare the thyroid hormonal profile in patients submitted to L-T4 treatment in tablets or liquid formulation with an enteral feeding tube; (2) evaluate the nursing compliance with the two different formulations. SUBJECTS AND METHODS 20 euthyroid patients submitted to total laryngectomy and thyroidectomy consecutively started L-T4 treatment in tablets (Group T) or in liquid formulation (Group L) with enteral feeding tube the day after surgery. Tablets were crushed before administration and enteral feeding was stopped for 30 min before and after L-T4 treatment, whereas liquid formulation was placed into the nasoenteric tube immediately. A questionnaire about the preparation and administration of thyroxine replacement therapy was given to the nurses. RESULTS No difference of TSH, fT4 and fT3 before and after L-T4 treatment was observed among patients of Group L. A slightly serum TSH increase was observed in Group T, but not reaching statistical significance (2.50 ± 1.18 vs 2.94 ± 1.22 mUI/L), whereas no difference in fT4 and fT3 levels was found. Preparation and administration of liquid L-T4 was considered excellent by 12/13 nurses, whereas tablet formulation was considered poor by 10/13. CONCLUSIONS Our data showed that liquid L-T4 formulation can be administered directly through feeding tube with no need for an empty stomach, with a significant improvement in therapy preparation and administration by nurses.
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Affiliation(s)
- I Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, c/o 1^ Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, Brescia, 25100, Italy
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Gad Z, Mohamed A, Fakhr I. When would we advocate a total thyroidectomy in cases of hypopharyngeal carcinoma? J Egypt Natl Canc Inst 2014; 26:93-8. [PMID: 24841160 DOI: 10.1016/j.jnci.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND AIM The incidence of invasion of the thyroid gland by hypopharyngeal carcinomas is reported to be up to 57%. Our aim was to analyze the frequency of thyroid gland invasion in hypopharyngeal carcinoma treated by thyroidectomy with total laryngopharyngectomy and to identify patients in whom preservation of the thyroid gland is oncologically feasible and hence reduces post-operative hypothyroidism. PATIENTS AND METHODS This retrospective cohort study included 58 patients with hypopharyngeal squamous cell carcinoma treated by thyroidectomy with total laryngopharyngectomy at the National Cancer Institute, Cairo University between May 1996 and October 2005. Thyroid gland involvement was analyzed through review of charts and pathologic reports. Patients were assessed preoperatively by CT. The correlation between the thyroid gland involvement and the clinical and radiologic CT findings was meticulously examined. RESULTS Thyroid gland involvement occurred in 37.9% (22/58) of all patients. T4 hypopharyngeal tumors were present in 29.3% (n=17/58) of patients, paratracheal LN invasion was present in 37.9% (22/58) of patients, thyroid cartilage invasion was obvious in 19% (11/58) of patients, and previous radiotherapy was present in 5.2% (3/58) of patients. All patients with T4 hypopharyngeal tumors (n=17/58) and with thyroid cartilage involvement (n=11/58) had thyroid gland invasion as well. T4 hypopharyngeal tumors, paratracheal LN invasion, and thyroid cartilage invasion were statistically significant factors (P<0.001, P=0.009 and P<0.001 respectively) in independent correlation. CONCLUSION We would advocate a total thyroidectomy in cases of advanced stages of hypopharyngeal carcinoma, bilateral tumors, postcricoid carcinoma and in all patients with definite radiological evidence of thyroid gland invasion.
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Affiliation(s)
- Zeiad Gad
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Abdelmaksoud Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ibrahim Fakhr
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
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Practice of laryngectomy rehabilitation interventions: a perspective from Hong Kong. Curr Opin Otolaryngol Head Neck Surg 2013; 21:205-11. [PMID: 23572016 DOI: 10.1097/moo.0b013e328360d84e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the current practice of rehabilitation for laryngectomees in Hong Kong. RECENT FINDINGS Factors affecting the quality of life of laryngectomees include their performance in speech restoration, the presence of complications of treatment, as well as the availability of psycho-social support. In Hong Kong, more than 90% of laryngectomees have speech restoration by various means, the commonest of which being tracheo-oesophageal puncture and electrolaryngeal speech. However, they face special problems in communication using the current alaryngeal speech modalities, as it is difficult to produce variation in tones, which is important to express different meanings in Cantonese. The responsibility of surgeons to follow-up patients after surgery and the practice of management of common complications after laryngectomy are also discussed. The New Voice Club of Hong Kong promotes self-help and mutual help between laryngectomees, with the aim of helping new members to regain normal speech and to re-integrate into society. Quality-of-life study in Hong Kong shows that although the mean global health score is satisfactory, the social functioning domain is most severely affected after surgery. SUMMARY Cantonese-speaking laryngectomees in Hong Kong are facing unique challenges in speech restoration and re-integration into society after surgery. Surgeons should take the leading role in the multidisciplinary management of these patients.
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Kumar R, Drinnan M, Robinson M, Meikle D, Stafford F, Welch A, Zammit-Maempel I, Paleri V. Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature. Clin Otolaryngol 2013; 38:372-8. [DOI: 10.1111/coa.12165] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
- R. Kumar
- Department of Otolaryngology-Head and Neck Surgery; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - M. Drinnan
- Department of Medical Physics; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - M. Robinson
- Department of Oral Pathology; School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - D. Meikle
- Department of Otolaryngology-Head and Neck Surgery; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - F. Stafford
- Department of Otolaryngology-Head and Neck Surgery; Mid Essex Hospital Services NHS Trust; Newcastle upon Tyne UK
| | - A. Welch
- Department of Otolaryngology-Head and Neck Surgery; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - I. Zammit-Maempel
- Department of Radiology; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - V. Paleri
- Department of Otolaryngology-Head and Neck Surgery; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
- Northern Institute for Cancer Research; Newcastle University; Newcastle upon Tyne UK
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A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma. Oral Oncol 2013; 49:950-955. [PMID: 23602256 DOI: 10.1016/j.oraloncology.2013.03.450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The incidences of hypo(para)thyroidism were assessed prospectively in 137 consecutive patients with laryngeal (84.7%) or hypopharyngeal (15.3%) carcinoma who were treated with surgery and/or radiotherapy between 2004 and 2006. MATERIAL AND METHODS Laboratory studies were performed in patients before primary or salvage treatment of a laryngeal or hypopharyngeal carcinoma and were repeated 6, 12, 18 and 24months after treatment. All patients were evaluated for the development of hypo(para)thyroidism, and the presence of autoantibodies. The association of hypothyroidism was analyzed against several patient parameters including tumor and treatment characteristics. RESULTS The incidence of hypothyroidism following treatment of laryngeal and hypopharyngeal carcinoma was 47.4%: 27.7% subclinical hypothyroidism and 19.7% clinical hypothyroidism. The median time to develop hypothyroidism was 10months. The incidence of hypoparathyroidism was 7.3%. Univariate analysis showed that patients with laryngectomy, hemithyroidectomy, neck dissection, paratracheal lymph node dissection and radiotherapy had a higher risk of developing hypothyroidism. Multivariate analysis showed laryngectomy, hemithyroidectomy, neck dissection and age to be predictive factors for the development of hypothyroidism. The combination of surgery and radiotherapy increased this risk. Hemithyroidectomy was the most important risk factor. CONCLUSION The incidence rate of hypothyroidism after treatment for laryngeal or hypopharyngeal cancer in this largest prospective study is high (47.4%), especially after combination treatment. Based on the intervals between treatment and the development of hypothyroidism, thyroid testing before treatment, every 3months during the first year, every 6months the second year and annually thereafter is recommended as screening procedure.
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Boomsma MJ, Bijl HP, Christianen MEMC, Beetz I, Chouvalova O, Steenbakkers RJHM, van der Laan BFAM, Wolffenbuttel BHR, Oosting SF, Schilstra C, Langendijk JA. A prospective cohort study on radiation-induced hypothyroidism: development of an NTCP model. Int J Radiat Oncol Biol Phys 2012; 84:e351-6. [PMID: 22717243 DOI: 10.1016/j.ijrobp.2012.05.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 04/22/2012] [Accepted: 05/10/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE To establish a multivariate normal tissue complication probability (NTCP) model for radiation-induced hypothyroidism. METHODS AND MATERIALS The thyroid-stimulating hormone (TSH) level of 105 patients treated with (chemo-) radiation therapy for head-and-neck cancer was prospectively measured during a median follow-up of 2.5 years. Hypothyroidism was defined as elevated serum TSH with decreased or normal free thyroxin (T4). A multivariate logistic regression model with bootstrapping was used to determine the most important prognostic variables for radiation-induced hypothyroidism. RESULTS Thirty-five patients (33%) developed primary hypothyroidism within 2 years after radiation therapy. An NTCP model based on 2 variables, including the mean thyroid gland dose and the thyroid gland volume, was most predictive for radiation-induced hypothyroidism. NTCP values increased with higher mean thyroid gland dose (odds ratio [OR]: 1.064/Gy) and decreased with higher thyroid gland volume (OR: 0.826/cm(3)). Model performance was good with an area under the curve (AUC) of 0.85. CONCLUSIONS This is the first prospective study resulting in an NTCP model for radiation-induced hypothyroidism. The probability of hypothyroidism rises with increasing dose to the thyroid gland, whereas it reduces with increasing thyroid gland volume.
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Affiliation(s)
- Marjolein J Boomsma
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Hilly O, Raz R, Vaisbuch Y, Strenov Y, Segal K, Koren R, Shvero J. Thyroid gland involvement in advanced laryngeal cancer: association with clinical and pathologic characteristics. Head Neck 2011; 34:1586-90. [PMID: 22180291 DOI: 10.1002/hed.21972] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 07/24/2011] [Accepted: 09/07/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Indications for thyroidectomy during laryngectomy are controversial. We examined whether clinicopathologic features can predict thyroid gland involvement, and the prognostic effect of thyroid gland involvement in patients undergoing total laryngectomy. METHODS The study set out to review preoperative assessment, operation findings, pathologic findings, and follow-up data. RESULTS Thyroid gland involvement was found in 11 of 53 patients (21%) undergoing total laryngectomy and thyroidectomy. Preoperative work-up failed to predict thyroid gland involvement. Thyroid gland involvement was associated with salvage procedures (p = .025), paratracheal metastases (p = .003), and poor overall survival (hazard ratio = 2.74, p = .008). CONCLUSIONS Thyroid gland involvement in patients undergoing total laryngectomy is frequent and is associated with poor prognosis. Preoperative assessment failed to predict thyroid gland involvement. We believe that thyroidectomy should be considered in cases with paratracheal lymphatic spread irrespective of tumor location within the larynx.
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Affiliation(s)
- Ohad Hilly
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Nozières C, Damatte-Fauchery C, Borson-Chazot F. Thyroid effects and anticancer treatment. ANNALES D'ENDOCRINOLOGIE 2011; 72:198-202. [PMID: 21640332 DOI: 10.1016/j.ando.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 01/12/2011] [Accepted: 04/11/2011] [Indexed: 05/30/2023]
Abstract
Thyroid consequences of cancer therapy are multiple, better known after radiotherapy than after chemotherapy and recently described with targeted therapies. Cervical or total body irradiation may result in thyroid insufficiency or cancer. The consequences of treatment with new antiangiogenic drugs are under evaluation; however their effect on thyroid function is already well established. Thyroid dysfunction usually occurs late, several months or years after treatment and have to be depicted. There is an improvement in the overall survival of patients suffering from cancer and endocrinologists must be aware of the endocrine effects of treatments to propose an adequate survey and an appropriate treatment to improve well-being of patients.
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Affiliation(s)
- C Nozières
- Fédération d'endocrinologie du pôle Est, groupement hospitalier Est, Bron, France.
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Vogelius IR, Bentzen SM, Maraldo MV, Petersen PM, Specht L. Risk factors for radiation-induced hypothyroidism: a literature-based meta-analysis. Cancer 2011; 117:5250-60. [PMID: 21567385 DOI: 10.1002/cncr.26186] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND A systematic overview and meta-analysis of studies reporting data on hypothyroidism (HT) after radiation therapy was conducted to identify risk factors for development of HT. METHODS Published studies were identified from the PubMed and Embase databases and by hand-searching published reviews. Studies allowing the extraction of odds ratios (OR) for HT in 1 or more of several candidate clinical risk groups were included. A meta-analysis of the OR for development of HT with or without each of the candidate risk factors was performed. Furthermore, studies allowing the extraction of radiation dose-response data were identified for a meta-analysis of the dose-response curve. RESULTS Female gender (OR = 1.6; 95% confidence interval [CI], 1.3-1.9; P < .00001), surgery involving the thyroid gland (OR = 8.3; 95% CI, 5.7-12.0; P < .00001), or other neck surgery (OR = 1.7; 95% CI, 1.16-2.42; P = .006) were associated with a higher risk of HT. Caucasians were at higher risk of HT than African Americans (OR = 4.8; 95% CI, 2.8-8.5; P < .00001). The data showed association between lymphangiography and HT but with evidence of publication bias. There was a radiation dose-response relation with a 50% risk of HT at a dose of 45 Gy but with considerable variation in the dose response between studies. Chemotherapy and age were not associated with risk of HT in this analysis. CONCLUSIONS Several clinical risk factors for HT were identified. The risk of HT increases with increasing radiation dose, but the specific radiation dose response varies between the studies. The most likely cause of this heterogeneity is differences in follow-up between studies.
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Affiliation(s)
- Ivan R Vogelius
- Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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The incidence of thyroid dysfunction following radiotherapy for early stage carcinoma of the larynx. Eur Arch Otorhinolaryngol 2011; 268:1519-22. [PMID: 21328003 DOI: 10.1007/s00405-011-1504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
External beam radiotherapy is currently the commonest form of treatment for early laryngeal cancer (T1/2) and thyroid dysfunction is a well recognised complication of this treatment. Overt hypothyroidism is a specific clinical disorder which in most patients will be recognized and treated. The problems associated with subclinical hypothyroidism (elevated TSH with normal T4), however, are only now being recognized and their management is to some extent still controversial. The aims of our study are to determine the incidence of clinical and subclinical hypothyroidism in those who have been treated solely with curative radiotherapy for early laryngeal cancer. We performed a retrospective observational study encompassing all patients who underwent curative radiotherapy for T1/T2 laryngeal cancer between 1998 and 2002. 33 patients were identified (mean 66.85 years, range 48-93). 19 patients had T1 lesions (58%), 14 had T2 lesions (42%) and 27 were N0 (82%). 23 patients were euthyroid post treatment (70%), 2 became overtly hypothyroid (6%) and 8 developed subclinical hypothyroidism (24%). There was no association between tumour stage (p = 0.97), nodal stage (p = 0.46) and thyroid status, however, there was an association between increasing age and deteriorating thyroid function (p = 0.01). Our study showed that of patients with early laryngeal cancers treated solely with curative radiotherapy 24% developed subclinical hypothyroidism and 6% were overtly hypothyroid (Elevated TSH and reduced T4). We feel patients should receive regular thyroid function testing following completion of treatment and should be adequately counselled on the risk of thyroid dysfunction following radiotherapy at pre-treatment visits.
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Elliott MS, Odell EW, Tysome JR, Connor SEJ, Siddiqui A, Jeannon JP, Simo R. Role of thyroidectomy in advanced laryngeal and pharyngolaryngeal carcinoma. Otolaryngol Head Neck Surg 2010; 142:851-5. [PMID: 20493357 DOI: 10.1016/j.otohns.2010.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/08/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Total thyroidectomy (TThy) or hemithyroidectomy (HThy) in conjunction with a total laryngectomy (TL) or pharyngolaryngectomy (PL) for laryngeal carcinoma often results in hypothyroidism requiring life-long thyroid hormone replacement. The aims were to determine the incidence of thyroid gland (TG) invasion in patients undergoing TL or TPL with TThy or HThy for laryngeal or hypopharyngeal carcinoma and to assess predicative factors. STUDY DESIGN Case series with chart review. SETTING Guy's Hospital, London, UK. SUBJECTS AND METHODS Thirty-five patients from 2004 to 2008 were reviewed. Specimens were examined to determine the incidence of TG invasion and predicative factors. Preoperative imaging was reviewed to assess the radiological evidence of TG invasion. RESULTS TL and TThy were performed in 19 patients, TL and HThy in three patients, and PL and TThy in 13 patients. Surgery was performed for primary and recurrent carcinoma in 28 and eight patients, respectively. Histological evidence of invasion of the TG was found in three patients (8.5%). No significant relationship was found between TG invasion and patient's sex, subsite of primary carcinoma, stage of primary disease at surgery, degree of differentiation, or the presence of subglottic extension. In addition, no significant relationship was found between the presence of TG invasion and recurrent disease. Definite evidence of radiological invasion of the TG was seen in only one patient. CONCLUSIONS Invasion of the TG in patients undergoing TL or TPL is a rare event and limits the need for TThy in most cases.
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Affiliation(s)
- Michael S Elliott
- Department of Otolaryngology, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
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Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy. Eur Arch Otorhinolaryngol 2009; 267:807-10. [DOI: 10.1007/s00405-009-1152-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
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Hypothyroidism in postradiation head and neck cancer patients: incidence, complications, and management. Curr Opin Otolaryngol Head Neck Surg 2009; 17:111-5. [PMID: 19373960 DOI: 10.1097/moo.0b013e328325a538] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe the incidence, risk factors, prevention, and management of hypothyroidism among patients treated with radiation and other modalities for head and neck cancers. RECENT FINDINGS Hypothyroidism may occur in up to 48% of patients treated for head and neck malignancies. It has been observed after radiation, surgery, and combined-modality therapies. The onset of hypothyroidism may be as early as 4 weeks and as late as 5 or 10 years after completion of therapy. It has been associated with poor wound healing, bleeding disorders, and a number of other potential complications germane to the practice of head and neck surgery. There is some evidence to suggest a protective role of hypothyroidism with respect to disease control survival in head and neck and other cancers. SUMMARY Hypothyroidism is common after treatment of head and neck cancers. Thyroid function studies should be obtained prior to and at regular intervals after treatment. Prompt recognition and intervention may prevent or reverse adverse physiological outcomes. Further studies are necessary to evaluate the role of permissive hypothyroidism in the context of treated head and neck malignancies.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo Galbo AM, de Bree R, Lips P, René Leemans C. Detecting hypothyroidism after treatment for laryngeal or hypopharyngeal carcinomas: a nationwide survey in The Netherlands. Eur Arch Otorhinolaryngol 2008; 266:713-8. [DOI: 10.1007/s00405-008-0797-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 08/14/2008] [Indexed: 10/21/2022]
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