Sequential changes in serum thyroglobulin, triiodothyronine, and thyroxine following partial thyroidectomy for nontoxic nodular goiter

Changes in TSH, T4, T3 and Thyroglobulin Levels throughout Total Thyroidectomy

Introduction: To assess the impact of total thyroidectomy on thyroid function. Methods: Monocentric observational prospective study. Patients who benefited from a total thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery between September 2017 and July 2019 were included. Three blood samples were taken from each patient during the perioperative period: preoperatively (T₀), intraoperatively (T₁), and postoperatively (T₂). Changes in TSH, T4, T3, and thyroglobulin levels were evaluated from T₀ to T₂. Epidemiological data were retrieved from the medical charts. Statistical analyses were performed for the entire cohort and subgroups regarding preoperative treatment and type of disease. Results: Seventy-seven patients were included in the study. T4 and thyroglobulin levels increased significantly from T₀ to T₁. TSH, T4, T3, and thyroglobulin levels decreased significantly from T₁ to T₂. Conclusions: Our study confirmed the hypothesis of variable kinetics of thyroid hormone levels associated with the manipulation of the thyroid gland during surgery, but none of these changes resulted in clinical effects, including thyrotoxicosis.

The value of serum thyroglobulin alteration after ultrasonography-guided fine-needle biopsy of suspicious cervical lymph nodes in the diagnosis of metastasis in patients with differentiated thyroid cancer

BACKGROUND

It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results.

MATERIAL AND METHODS

Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TG_b-FNC ), after FNC (TG_a-FNC ), TG_a-FNC /TG_b-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results.

RESULTS

TG_a-FNC , TG_b-FNC /TG_a-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TG_b-FNC /TG_a-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups.

CONCLUSIONS

Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.

Serum thyroglobulin levels after fine-needle aspiration of thyroid nodules

OBJECTIVE

To investigate whether a minor insult to the thyroid gland attributable to fine-needle aspiration (FNA) or external thyroid palpation can cause a release of serum thyroglobulin (Tg) into the circulation.

METHODS

We determined serum Tg levels before and at 60 minutes and 15 days after FNA in 25 patients with thyroid nodules. Results were compared with those obtained in 25 patients with thyroid nodules, in whom serum Tg concentrations were determined before and 60 minutes after palpation of the thyroid, and in 15 healthy subjects without thyroid disease, who had no thyroid palpation and no FNA, from whom 2 blood specimens were obtained 60 minutes apart. All participants had normal results of thyroid function tests and no detectable antithyroglobulin or thyroid peroxidase antibodies.

RESULTS

After FNA, 22 of 25 patients had significant elevation of serum Tg concentrations. The Tg levels returned to baseline values 15 days after FNA. In 4 of the 25 patients with thyroid nodules who had palpation of the thyroid, a significant increase in serum Tg levels was elicited. None of the 15 healthy subjects with normal thyroid glands (and with no FNA or thyroid palpation) had significant Tg elevations.

CONCLUSION

FNA causes a significant increase in serum Tg concentrations, which may persist for 15 days. Therefore, Tg assay should not be scheduled prematurely after FNA.

Detecting and defining hypothyroidism after hemithyroidectomy

BACKGROUND

The incidence of hypothyroidism after hemithyroidectomy for benign thyroid disease remains uncertain. This study examines the incidence, natural history, and the factors contributing to hypothyroidism after hemithyroidectomy.

METHODS

A retrospective review of patients undergoing hemithyroidectomy over 37 months was performed. The incidence of postoperative hypothyroidism was based on thyrotropin values and clinical symptoms. The relationship between hypothyroidism and lymphocytic infiltration of the removed gland was investigated using stepwise logistic regression.

RESULTS

Twelve of 66 patients (18%) became biochemically hypothyroid postoperatively. Four of the 12 patients (33%) subsequently became euthyroid without intervention. Of the remaining 8 patients, 4 (50%) had significant lymphocytic infiltration in the resected gland compared with 10 (19%) of the 54 euthyroid patients. Lymphocytic infiltration was associated with hypothyroidism but was age dependent.

CONCLUSIONS

A minority of patients become hypothyroid after hemithyroidectomy. Some patients with biochemical hypothyroidism will become euthyroid without intervention. The impact of lymphocytic infiltrate on hypothyroidism after hemithyroidectomy is age dependent.

Safety of video-assisted thyroidectomy versus conventional surgery

BACKGROUND

Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT.

METHODS

Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified.

RESULTS

No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome.

CONCLUSIONS

VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.

Development of postpartum spontaneously resolving transient Graves' hyperthyroidism followed immediately by transient hypothyroidism

A 25-year-old woman with a history of Graves' disease, in remission for 8.5 years following 6 months of methimazole therapy, first came to our attention 5 months after her first delivery with clinical and biochemical hypothyroidism, markedly elevated titre of anti-thyroid microsomal antibody (MCHA; 1:102400) and mildly elevated activity of thyrotropin-binding inhibitory immunoglobulins (TBII; 29.5%). After short-term (3 months) treatment with L-thyroxine therapy, the development of hyperthyroidism in the first trimester of the second pregnancy, which remitted through the second and third trimesters, was observed. TBII showed a peak value (93.1%) 1 month after the onset of hyperthyroidism, and a normal value (12.4%) 6 d after delivery. One month after the second delivery, the patient developed hyperthyroidism, with an elevation of 99mTc thyroid uptake (5.58%; normal range 0.5-2.5%), which was immediately followed by transient clinical and biochemical hypothyroidism. Concomitant increases in MCHA titre and TBII activity were observed after delivery, and both reached peak levels (1:409600 and 81.0%, respectively) one and a half months after the onset of hypothyroidism. Thyroid-stimulating antibody (TSAb), measured using FRTL-5 thyroid cells, was detected at a weakly positive level (161%) on initial examination, and the serial change in TSAb was almost identical to that in TBII. Patients with Graves' disease may develop Graves' type hyperthyroidism, followed immediately by transient hypothyroidism due to coexisting destructive autoimmune thyroiditis during the early postpartum period, despite increasing TSAb activity.

Disappearance of thyroid-stimulation blocking antibody by glucocorticoid therapy in a patient with primary myxedema who developed aortitis syndrome during L-thyroxine supplementation

A 39-year-old woman with primary myxedema, who had the potent activities of thyrotropin-binding inhibitory immunoglobulins (TBII) and thyroid-stimulation blocking antibodies (TSBAb), developed aortitis syndrome about 6 months after the initiation of L-thyroxine (L-T4) supplementation. A 35 mg daily dose of prednisolone for aortitis syndrome was initiated, and the dose was gradually reduced. TBII and TSBAb activities were gradually decreased, and both reached normal levels (7.7% and 10.1%, respectively) 3 months after the initiation of prednisolone. Therefore, dose of L-T4 was gradually reduced, and L-T4 supplementation was stopped. Subsequently, however, recurrence of hypothyroidism was not observed. These observations indicate the possibility that hypothyroidism remits with disappearance of TBII and TSBAb activities in not only neonatal cases but also adult cases.