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Apostolou K, Paunovic I, Frountzas M, Zivaljevic V, Tausanovic K, Karanikas M, Koutelidakis I, Schizas D. Posthemithyroidectomy Hypothyroidism: Updated Meta-Analysis of Risk Factors and Rates of Remission. J Surg Res 2024; 293:102-120. [PMID: 37734294 DOI: 10.1016/j.jss.2023.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for hypothyroidism, both clinical and subclinical, following hemithyroidectomy in preoperatively euthyroid patients, as well as hypothyroidism remission and its time of remission. MATERIALS AND METHODS A search was performed in Medline (via PubMed), Web of Science, and the Cochrane Library using the keywords "hemithyroidectomy + postoperative + hypothyroidism" and "hemithyroidectomy + hormone supplementation". RESULTS Fifty-four studies with a total of 9,999 patients were included. After a mean follow-up interval of 48.2 mo, the pooled hypothyroidism rate was 29%. The subclinical hypothyroidism rate was 79% of patients with hypothyroidism (18 studies). Moreover, a meta-analysis of 12 studies indicated a pooled hypothyroidism remission rate after hemithyroidectomy of 42% (95% CI: 24%-60%). Older patient age (MD = -2.54, 95% CI = -3.99, -1.10, P = 0.0006), female gender (OR = 0.69, 95% CI = 0.58, 0.82, P < 0.0001), higher preoperative thyroid-stimulating hormone levels (MD = -0,81, 95% CI = -0.96, -0.66, P < 0.00001), pathological preoperative anti-thyroid peroxidase antibodies (OR = 0.37, 95% CI = 0.24, 0.57, P < 0.00001) and anti-thyroglobulin antibodies (OR = 0.52, 95% CI = 0.36, 0.75, P = 00,005), and right-sided hemithyroidectomy (OR = 0.54, 95% CI = 0.43, 0.68, P < 0.00001) were associated with postoperative hypothyroidism development. In metaregression analysis, Asia presented a significantly higher hypothyroidism rate after hemithyroidectomy (34.6%, 95% CI = 29.3%-9.9%), compared to Europe (22.9%, 95% CI = 16.2%-29.5%, P = 0.037) and Canada (1.8%, 95% CI = -22.6%-26.2%, P = 0.013). CONCLUSIONS Hypothyroidism is a frequent and significant postoperative sequela of hemithyroidectomy, necessitating individualization of treatment strategy based on the underlying disease as well as the estimated risk of hypothyroidism and its risk factors.
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Affiliation(s)
- Konstantinos Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Ivan Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maximos Frountzas
- 1st Department of Propaedeutic Surgery, Medical School University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Vladan Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Tausanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michael Karanikas
- 1st University Surgical Department, University Hospital of Alexandropoulis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Koutelidakis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Cao XJ, Yu MA, Zhu YL, Qi L, Cong ZB, Yan GZ, Liu J, Wang HL, Liu G, Guo JQ, Hao Y, Wang ZH, Wang X, He JF, Shataer A, Liu XF, Zhao ZL, Wei Y, Peng LL, Li Y, Wang SR, Che Y. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study. Int J Hyperthermia 2021; 38:916-922. [PMID: 34148494 DOI: 10.1080/02656736.2021.1936218] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Ultrasound-guided thermal ablation (including microwave ablation [MWA] and radiofrequency ablation [RFA]) has emerged as a remarkable technology for the treatment of benign and malignant diseases. The objective of this multicenter study was to assess the efficacy and safety of thermal ablation in a large cohort of patients with papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS Retrospective study of 725 patients who underwent MWA/RFA at 11 centers between March 2015 and March 2020. The mean age of patients was 46 ± 11 years (range, 22-81); the mean follow-up time was 21 ± 13 months (range, 6-60). Changes in size of tumor, the rates of tumor disappearance, disease progression, and complications were assessed. RESULTS From 6 months post-ablation, the size of tumors was significantly reduced compared with those recorded pre-ablation (p < 0.001 for all). Five hundred and fifteen (71.0%) PTMCs had completely disappeared as assessed by ultrasound examination. Six (0.8%) patients developed disease progression post-ablation; of these, 5 (0.7%) patients developed new PTMCs, while one (0.1%) patient developed cervical lymph node metastasis. Nineteen (2.6%) patients developed complications post-ablation; of these 14 (1.9%) patients developed voice hoarseness, 4 (0.6%) developed hematoma, and one (0.1%) patient developed cough. CONCLUSIONS Ultrasound-guided thermal ablation represents an effective and safe treatment for patients with PTMC besides active surveillance and surgery.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ya-Lin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Qi
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Guo-Zhen Yan
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner, Mongolia University of Science and Technology, Baotou, China
| | - Juan Liu
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
| | - Hong-Ling Wang
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Geng Liu
- Department of Ultrasound, Wuhai People's Hospital, Wuhai, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China
| | - Ying Hao
- Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China
| | - Zhong-Hua Wang
- Special Inspection Section, Wendeng District People's Hospital, Weihai, China
| | - Xue Wang
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner, Mongolia University of Science and Technology, Baotou, China
| | - Aini Shataer
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiao-Fang Liu
- Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China.,Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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Li Z, Qiu Y, Fei Y, Xing Z, Zhu J, Su A. Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis. Endocrine 2020; 70:243-255. [PMID: 32638212 DOI: 10.1007/s12020-020-02410-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/27/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE This systematic review and meta-analysis evaluated the prevalence of and risk factors for hypothyroidism following hemithyroidectomy as new evidence obtained in recent years warranted an update of previous meta-analyses. METHODS The PubMed, Embase, and Cochrane Library databases were searched through November 1, 2019, for articles examining the hypothyroidism prevalence and risk factors after lobectomy. The prevalence rate, risk ratio (RR), weighted mean difference (WMD) and standardized mean difference (SMD) were assessed by conducting a meta-analysis of proportions, binary variables, and continuous variables, respectively, using random-effects models. RESULTS Fifty-one studies showed a pooled risk of 29.9% (95% confidence interval (CI), 24.6-35.2%) for hypothyroidism following hemithyroidectomy. Risk factors for the development of postoperative hypothyroidism included the female sex (RR, 1.169; 95% CI, 1.040-1.314; P = 0.009), a higher preoperative thyrotropin (TSH) level (RR, 2.955; 95% CI, 2.399-3.640; P = 0.000), a lower preoperative FT4 level (SMD, -0.818; 95% CI, -1.623--0.013; P = 0.047), concomitant lymphocyte infiltration (RR, 1.558; 95% CI, 1.203-2.018; P = 0.001), Hashimoto's thyroiditis (HT) (RR, 1.480; 95% CI, 1.192-1.838; P = 0.000), a lighter weight of the remaining gland (WMD, -2.740; 95% CI, -3.708--1.772; P = 0.000), and a right side lobectomy (RR, 1.404; 95% CI, 1.075-1.835; P = 0.013). CONCLUSIONS Hypothyroidism is a significant complication after lobectomy, and appropriate and personalized surgical strategies should be designed after a careful preoperative assessment based on the estimated risk of hypothyroidism and risk factors.
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Affiliation(s)
- Zhe Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yuxuan Qiu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yuan Fei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhichao Xing
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Anping Su
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China.
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Kaya S, Yuksek MO, Sari R, Altin O, Sikar H, Kucuk H. Is hemithyroidectomy sufficient in unilateral benign nodular goitre? Minerva Endocrinol (Torino) 2020; 46:406-412. [PMID: 32969625 DOI: 10.23736/s2724-6507.20.03203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. METHODS Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. RESULTS A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. CONCLUSIONS Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.
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Affiliation(s)
- Selcuk Kaya
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa O Yuksek
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Sari
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey -
| | - Onder Altin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan Sikar
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan Kucuk
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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