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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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2
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Nassar AA, Shoaib AA, Dewidar HM, Azooz KO. Incidence of Post Total Laryngectomy Hypothyroidism: Effects of Thyroid Gland Surgery and Post-Operative Radiotherapy. Indian J Otolaryngol Head Neck Surg 2023; 75:1336-1343. [PMID: 37636632 PMCID: PMC10447349 DOI: 10.1007/s12070-023-03562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
To record the incidence of hypothyroidism in patients after total laryngectomy, whether with or without postoperative radiation therapy and to analyze the effect of hemithyroidectomy for the development of hypothyroidism. A retrospective study included patients who underwent total laryngectomy (with or without hemithyroidectomy) between 2018 and 2021 for laryngeal carcinoma and/or received postoperative radiotherapy. Thirty-six (45%) of the 80 enrolled patients developed hypothyroidism after a median follow-up of 16 months. In this study, adjuvant radiation and central neck dissection were found to be significantly linked with developing post-operative hypothyroidism (p values: 0.001, 0.007, respectively). The incidence of hypothyroidism in patients treated for laryngeal carcinoma is high, especially after combination treatment of surgery and radiotherapy.
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Affiliation(s)
- Ahmed Amin Nassar
- Otolaryngology Department, Faculty of Medicine, Cairo University, 4 Mohamed Yousef Othman ST, Al Zohour District, Omraneya, Giza, Cairo, 12552 Arab Republic of Egypt
| | - Abdelrahman Ahmed Shoaib
- Otolaryngology Department, Faculty of Medicine, Cairo University, 4 Mohamed Yousef Othman ST, Al Zohour District, Omraneya, Giza, Cairo, 12552 Arab Republic of Egypt
| | - Hazem Mohammed Dewidar
- Otolaryngology Department, Faculty of Medicine, Cairo University, 4 Mohamed Yousef Othman ST, Al Zohour District, Omraneya, Giza, Cairo, 12552 Arab Republic of Egypt
| | - Khaled Omar Azooz
- Otolaryngology Department, Faculty of Medicine, Cairo University, 4 Mohamed Yousef Othman ST, Al Zohour District, Omraneya, Giza, Cairo, 12552 Arab Republic of Egypt
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3
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Okafor S, Awaonusi OO, Watts TL, Cannon TY. Salvage Surgery. Otolaryngol Clin North Am 2023; 56:323-331. [PMID: 37030945 DOI: 10.1016/j.otc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The Department of Veterans Affairs Laryngeal Cancer Study propelled the combination of chemotherapy and radiation therapy to the forefront of strategies used for the management of locally advanced laryngeal cancer. The organ preservation rate was 84%. However, over the past 30 years that these approaches have been in place, there have been concerns regarding long-term survival and high failure rates requiring salvage. Furthermore, salvage laryngectomy, if feasible when considering increased morbidity after CRT, is fraught with a higher risk of wound complications including fistula, longer hospitalization, and reduced quality of life.
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Affiliation(s)
- Somtochi Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA
| | - Oluwaseyi O Awaonusi
- Indian University, School of Medicine, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - Tammara L Watts
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA; Department of Head and Neck Surgery & Communication Sciences, Duke Raleigh Hospital, 3404 Wake Forest Road Suite 202, Raleigh, NC 27609, USA.
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4
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Xie J, Liu H, Wu P, Chen L, Ge P, Chen S, Zhang S, Lu Z. Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221098300. [PMID: 35533678 DOI: 10.1177/01455613221098300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.
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Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Hui Liu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Peiyan Wu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangsi Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyi Zhang
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Weng JJ, Wei JZ, Li M, Ning LP, Liu F, Wei YZ, Xiong WM, Zhang BJ, Lu JL, Jiang H, Lu QT, Qu SH. Prognostic value of hypothyroidism in patients undergoing intensity-modulated radiation therapy for nasopharyngeal carcinoma. Head Neck 2022; 44:1114-1123. [PMID: 35170140 DOI: 10.1002/hed.27006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of hypothyroidism and thyroxine replacement therapy on the prognosis of nasopharyngeal carcinoma (NPC) patients. METHODS The clinical data of 284 NPC patients, who received intensity-modulated radiation therapy (IMRT) between January 2011 and December 2016, were retrospectively analyzed. RESULTS Hypothyroidism occurred in 38% of patients. Patients with hypothyroidism had significantly better disease-free survival (DFS) (p = 0.002) and relapse-free survival (RFS) (p = 0.008). Multivariate analysis showed that hypothyroidism was a positive independent prognostic factor (DFS and RFS). Among the patients with hypothyroidism, thyroxine replacement therapy did not yield inferior survival (DFS, RFS, all p > 0.05). CONCLUSIONS The NPC patients with complete response are at risk of hypothyroidism, which is attributable to escalating dose. These patients experienced clinical hypothyroidism could be adequately treated with thyroid hormone replacement. Further investigation of the underlying biological mechanism and potential therapeutic implications are required.
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Affiliation(s)
- Jing-Jin Weng
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jia-Zhang Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Min Li
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Le-Ping Ning
- Department of Laboratory Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Fei Liu
- Research Center of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yun-Zhong Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Wei-Ming Xiong
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Ben-Jian Zhang
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jin-Long Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - He Jiang
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qiu-Tian Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Shen-Hong Qu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
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Pasha HA, Wasif M, Ikram M, Hammad M, Ghaloo SK, Rashid Z. Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension. Int Arch Otorhinolaryngol 2022; 26:e574-e578. [PMID: 36405478 PMCID: PMC9668439 DOI: 10.1055/s-0041-1740200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.
Objective
To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.
Methods
We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.
Results
We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (
p
= 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.
Conclusion
Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.
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Affiliation(s)
- Hamdan Ahmed Pasha
- Department of Otolaryngology and Head and Neck Surgery, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Wasif
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hammad
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shayan Khalid Ghaloo
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Zafar Rashid
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
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7
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de Lima NRB, de Souza Junior FG, Roullin VG, Pal K, da Silva ND. Head and Neck Cancer Treatments from Chemotherapy to Magnetic Systems: Perspectives and Challenges. Curr Radiopharm 2021; 15:2-20. [PMID: 33511961 DOI: 10.2174/1874471014999210128183231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cancer is one of the diseases causing society's fears as a stigma of death and pain. Head and Neck Squamous Cell Carcinoma (HNSCC) is a group of malignant neoplasms of different locations in this region of the human body. It is one of the leading causes of morbidity and mortality in Brazil, because these malignant neoplasias, in most cases, are diagnosed in late phases. Surgical excision, chemotherapy and radiotherapy encompass the forefront of antineoplastic therapy; however, the numerous side effects associated with these therapeutic modalities are well known. Some treatments present enough potential to help or replace conventional treatments, such as Magnetic Hyperthermia and Photodynamic Therapy. Such approaches require the development of new materials at the nanoscale, able to carry out the loading of their active components while presenting characteristics of biocompatibility mandatory for biomedical applications. OBJECTIVE This work aims to make a bibliographical review of HNSCC treatments. Recent techniques proven effective in other types of cancer were highlighted and raised discussion and reflections on current methods and possibilities of enhancing the treatment of HNSCC. METHOD The study was based on a bibliometric research between the years 2008 and 2019 using the following keywords: Cancer, Head and Neck Cancer, Chemotherapy, Radiotherapy, Photodynamic Therapy, and Hyperthermia. RESULTS A total of 5.151.725 articles were found, 3.712.670 about cancer, 175.470 on Head and Neck Cancer, 398.736 on Radiotherapy, 760.497 on Chemotherapy, 53.830 on Hyperthermia, and 50.522 on Photodynamic Therapy. CONCLUSION The analysis shows that there is still much room for expanding research, especially for alternative therapies since most of the studies still focus on conventional treatments and on the quest to overcome their side effects. The scientific community needs to keep looking for more effective therapies generating fewer side effects for the patient. Currently, the so-called alternative therapies are being used in combination with the conventional ones, but the association of these new therapies shows great potential, in other types of cancer, to improve the treatment efficacy.
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Affiliation(s)
- Nathali R B de Lima
- Biopolymer & Sensors Lab. - Instituto de Macromoléculas Professora Eloisa Mano, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco J. Universidade Federal de Rio de Janeiro, Zip code 21941-909,. Brazil
| | - Fernando G de Souza Junior
- Biopolymer & Sensors Lab. - Instituto de Macromoléculas Professora Eloisa Mano, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco J. Universidade Federal de Rio de Janeiro, Zip code 21941-909,. Brazil
| | - Valérie G Roullin
- Faculté de Pharmacie Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de la polytechnique Montreal QC, H3T 1J4,. Canada
| | - Kaushik Pal
- Wuhan University, Hubei Province, 8 East Lake South Road. Wuchang 430072,. China
| | - Nathalia D da Silva
- Programa de Engenharia da Nanotecnologia, COPPE, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco I. Universidade Federal de Rio de Janeiro,. Brazil
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8
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Plaat RE, van Dijk BAC, Muller Kobold AC, Steenbakkers RJHM, Links TP, van der Laan BFAM, Plaat BEC. Onset of hypothyroidism after total laryngectomy: Effects of thyroid gland surgery and preoperative and postoperative radiotherapy. Head Neck 2019; 42:636-644. [PMID: 31833166 PMCID: PMC7154538 DOI: 10.1002/hed.26048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/03/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background To determine time of onset and risk of hypothyroidism after total laryngectomy (TL) with and without (hemi)thyroidectomy in relation to treatment regimen, that is, preoperative radiotherapy (RT‐TL), postoperative radiotherapy (TL‐RT), and postoperative re‐irradiation (RT‐TL‐RT). Methods Retrospective review of 128 patients treated by RT‐TL (51 patients), TL‐RT (55 patients), and RT‐TL‐RT (22 patients). Risk of hypothyroidism was determined by multivariable Cox regression analysis and euthyroid survival was calculated using Kaplan‐Meier method. Results Hypothyroidism developed in 69 (54%) patients. The median onset of hypothyroidism was later (P < .01) and the risk of hypothyroidism was lower (hazard ratio 0.49; P = .014) in the TL‐RT group compared to both other treatment regimens. Euthyroid survival did not differ between the treatment regimens. Two years euthyroid survival was 24% with and 61% without (hemi)thyroidectomy (P < .001). Conclusions Patients treated with TL‐RT have later onset of hypothyroidism. Higher risk for hypothyroidism is associated with salvage TL after radiotherapy and (hemi)thyroidectomy.
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Affiliation(s)
- Robert E Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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