1
|
Cooper D, Kaur R, Ayeni FE, Eslick GD, Edirimanne S. Hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis. Thyroid Res 2024; 17:18. [PMID: 38972987 PMCID: PMC11229296 DOI: 10.1186/s13044-024-00200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/12/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The incidence of hypothyroidism following hemithyroidectomy and risk factors associated with its occurrence are not completely understood. This systematic review investigated the incidence and risk factors for hypothyroidism, thyroxine supplementation following hemithyroidectomy as well as the course of post-operative hypothyroidism, including the time to hypothyroidism and incidence of transient hypothyroidism. METHODS Searches were conducted in MEDLINE, EMBASE, Scopus, and Cochrane library for studies reporting the incidence of hypothyroidism or thyroxine supplementation following hemithyroidectomy. RESULTS Sixty-six studies were eligible for inclusion: 36 reported risk factors, and 27 reported post-operative course of hypothyroidism. Median follow-up was 25.2 months. The pooled incidence of hypothyroidism was 29% (95% CI, 25-34%; P<0.001). Transient hypothyroidism occurred in 34% of patients (95% CI, 21-47%; P<0.001). The pooled incidence of thyroxine supplementation was 23% (95% CI, 19-27%; P<0.001), overt hypothyroidism 4% (95% CI, 2-6%, P<0.001). Risk factors for development of hypothyroidism included pre-operative thyroid stimulating hormone (TSH) (WMD, 0.87; 95% CI, 0.75-0.98; P<0.001), TSH ≥ 2 mIU/L (RR, 2.87; 95% CI, 2.43-3.40; P<0.001), female sex (RR, 1.19; 95% CI, 1.08-1.32; P=0.007), age (WMD, 2.29; 95% CI, 1.20-3.38; P<0.001), right sided hemithyroidectomy (RR, 1.35; 95% CI, 1.10-1.65, P=0.003), the presence of autoantibodies anti-TPO (RR, 1.92; 95% CI, 1.49-2.48; P<0.001), anti-Tg (RR, 1.53; 95% CI, 1.40-1.88; P<0.001), and Hashimoto's thyroiditis (RR, 2.05; 95% CI, 1.57-2.68; P=0.001). CONCLUSION A significant number of patients will develop hypothyroidism or require thyroxine following hemithyroidectomy. An awareness of patient risk factors and postoperative thyroid function course will assist in counselling patients on their risk profile and guiding management.
Collapse
Affiliation(s)
- Dominic Cooper
- The University of Sydney School of Medicine, Sydney, Australia
| | | | - Femi E Ayeni
- Nepean Institute of Academic Surgery, The University of Sydney School of Medicine, 62 Derby St, Kingswood, Sydney, NSW, 2750, Australia.
- The University of Sydney School of Medicine, Nepean Clinical School, Sydney, Australia.
| | - Guy D Eslick
- The University of Sydney School of Medicine, Nepean Clinical School, Sydney, Australia
| | - Senarath Edirimanne
- Nepean Institute of Academic Surgery, The University of Sydney School of Medicine, 62 Derby St, Kingswood, Sydney, NSW, 2750, Australia
- The University of Sydney School of Medicine, Nepean Clinical School, Sydney, Australia
| |
Collapse
|
2
|
Huang Y, Jiang H, Xu G, Li X, Chen W, Lun Y, Zhang J. Comprehensive analysis of cellular senescence and immune microenvironment in papillary thyroid carcinoma. Aging (Albany NY) 2024; 16:2866-2886. [PMID: 38329430 PMCID: PMC10911381 DOI: 10.18632/aging.205520] [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: 05/11/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024]
Abstract
Senescence-induced therapy was previously considered as an effective treatment for tumors, and cellular senescence was initially regarded as an effective mechanism against cancer. However, whether cell senescence-related genes can be used to predict the prognosis of papillary thyroid carcinoma (PTC) and immunotherapy remains unclear. We developed and validated a cell senescence-related signature (CSRS) by analyzing the gene expression of 278 genes related to cellular senescence in 738 patients with PTC. Additionally, further analysis showed that CSRS was a reliable predictor of patient outcomes in combination with immune checkpoint expression and drug susceptibility, and patients with high risk scores may benefit from immunotherapy. The findings of this study demonstrate that CSRS serves as an immunotherapeutic response and prognosis biomarker affecting the tumor immune microenvironment of PTC.
Collapse
Affiliation(s)
- Yinde Huang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing 401147, China
| | - Han Jiang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| | - Guangwen Xu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| | - Xin Li
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| | - Wenbin Chen
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| | - Yu Lun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| | - Jian Zhang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shen-Yang 110001, Liaoning, China
| |
Collapse
|
3
|
Jiang Y, Sun X, Jiang M, Min H, Wang J, Fu X, Qi J, Yu Z, Zhu X, Wu Y. Impact of a mobile health intervention based on multi-theory model of health behavior change on self-management in patients with differentiated thyroid cancer: protocol for a randomized controlled trial. Front Public Health 2024; 12:1327442. [PMID: 38282759 PMCID: PMC10808536 DOI: 10.3389/fpubh.2024.1327442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Theoretical models of health behavior are important guides for disease prevention and detection, treatment and rehabilitation, and promotion and maintenance of physical and mental health, but there are no intervention studies related to differentiated thyroid cancer (DTC) that use theoretical models of health as a guide. In this study, we used a microblogging platform as an intervention vehicle and mobile patient-doctor interactive health education as a means of intervention, with the aim of improving the health behaviors of DTC patients as well as the corresponding clinical outcomes. Methods This research project is a quantitative methodological study, and the trial will be a single-blind, single-center randomized controlled trial conducted at the Fourth Hospital of Harbin Medical University in Harbin, Heilongjiang Province. The study subjects are patients over 18 years of age with differentiated thyroid cancer who were given radioactive iodine-131 therapy as well as endocrine therapy after radical surgery for thyroid cancer. The intervention group will receive MTM-mhealth, and the realization of health education will rely on the smart terminal WeChat platform. Routine discharge education will be given to the control group at discharge. The primary outcome will be change in thyroid-stimulating hormone (TSH) from baseline and at 3 and 6 months of follow-up, and secondary outcomes will include change in self-management behavior, social cognitive and psychological, and metabolic control. Discussion This study will explore a feasible mHealth intervention program applied to a population of DTC patients using the Multi-theory model of health behavior change (MTM) as a guide, with the aim of evaluating the MTM-based intervention program for clinical outcome improvement in DTC patients, as well as determining the effectiveness of the MTM-based intervention program in improving self-management skills in DTC patients. The results of this study will indicate the feasibility as well as the effectiveness of the application of health theoretical modeling combined with mHealth applications in disease prognostic health management models, and provide policy recommendations and technological translations for the development of mobility-based health management applications in the field of health management.
Collapse
Affiliation(s)
- Yang Jiang
- Jitang College, North China University of Science and Technology, Tangshan, China
| | - Xiangju Sun
- Clinical Pharmacy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Maomin Jiang
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Jing Wang
- School of Public Health, Peking University, Beijing, China
| | - Xinghua Fu
- The Fourth School of Clinical Medicine, Harbin Medical University, Harbin, China
| | - Jiale Qi
- School of Journalism and Communication, Zhengzhou University, Zhengzhou, China
| | - Zhenjie Yu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaomei Zhu
- Department of Pharmacy, Beidahuang Group General Hospital, Harbin, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| |
Collapse
|
4
|
Carlisle KM, Brown JP, Kim J, Turner DJ, Slejko JF, Kuo JH, Mullins CD, Hu Y. Age-stratified comparison of active surveillance versus radiofrequency ablation for papillary thyroid microcarcinoma using decision analysis. Surgery 2024; 175:153-160. [PMID: 37872047 PMCID: PMC10845124 DOI: 10.1016/j.surg.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Papillary thyroid microcarcinomas may be treated with radiofrequency ablation, active surveillance, or surgery. The objective of this study was to use mathematical modeling to compare treatment alternatives for papillary thyroid microcarcinomas among those who decline surgery. We hypothesized that radiofrequency ablation would outperform active surveillance in avoiding progression and surgery but that the effect size would be small for older patients. METHODS We engaged stakeholders to identify meaningful long-term endpoints for papillary thyroid microcarcinoma treatment-(1) cancer progression/surgery, (2) need for thyroid replacement therapy, and (3) permanent treatment complication. A Markov decision analysis model was created to compare the probability of these endpoints after radiofrequency ablation or active surveillance for papillary thyroid microcarcinomas and overall cost. Transition probabilities were extracted from published literature. Model outcomes were estimated to have a 10-year time horizon. RESULTS The primary outcome yielded a number needed to treat of 18.1 for the avoidance of progression and 27.4 for the avoidance of lifelong thyroid replacement therapy for radiofrequency ablation compared to active surveillance. However, as patient age increased, the number needed to treat to avoid progression increased from 5.2 (age 20-29) to 39.1 (age 60+). The number needed to treat to avoid lifelong thyroid replacement therapy increased with age from 7.8 (age 20-29) to 59.3 (age 60+). The average 10-year cost/treatment for active surveillance and radiofrequency ablation were $6,400 and $11,700, respectively, translating to a cost per progression-avoided of $106,500. CONCLUSION As an alternative to active surveillance, radiofrequency ablation may have a greater therapeutic impact in younger patients. However, routine implementation may be cost-prohibitive for most patients with papillary thyroid microcarcinomas.
Collapse
Affiliation(s)
- Kendyl M Carlisle
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Jessica P Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Justin Kim
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Douglas J Turner
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Jennifer H Kuo
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - C Daniel Mullins
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Yinin Hu
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD.
| |
Collapse
|
5
|
Lu PG, Ven Fong Z, Hangge PT, Chang YH, Lim ES, Wasif N, Cronin PA, Stucky CC. Differential utilization of thyroid lobectomy after the 2015 American Thyroid Association guideline update. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2024; 4:e240010. [PMID: 39246628 PMCID: PMC11378144 DOI: 10.1530/eo-24-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/30/2024] [Indexed: 09/10/2024]
Abstract
Background The 2015 American Thyroid Association (ATA) guidelines added thyroid lobectomy (TL) as the appropriate treatment for low-risk differentiated thyroid cancer (DTC). We aimed to investigate the population-level factors that influence the utilization of TL. Methods The Surveillance, Epidemiology and End Results (SEER) database was queried for all DTC patients fitting low-risk criteria as defined by the ATA. Trends in total thyroidectomy (TT) and TL were identified using a Cochrane-Armitage test. Multivariable logistic regression identified patient and socioeconomic characteristics associated with TL, and difference-in-difference analysis was used to control for secular trends over time. Results A total of 43,526 patients with low-risk DTC were identified in the SEER database; 39,411 pre-2015 and 4115 post-2015. After 2015, TT continued to outnumber TL (76.2% vs 23.8%), although the rate of TL increased significantly (11.6% to 23.8%, P < 0.001). However, difference-in-difference analysis found that age > 55 (OR 1.11, 95% CI 1.01-1.19, P < 0.001) and rurality (OR 1.16, 95% CI 1.05-1.28, P < 0.001) were independently associated with TT. TL was associated with T1 disease (OR 1.11, 95% CI 1.04-1.19, P = 0.001). Conclusion Although the 2015 ATA guideline update led to an increase in TL for low-risk DTC, most patients still underwent TT. Age and neighborhood significantly impact the odds of receiving guideline-appropriate TL for low-risk DTC, especially for T2 disease.
Collapse
Affiliation(s)
- Patricia Gina Lu
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Zhi Ven Fong
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Patrick T Hangge
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Yu-Hui Chang
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Elisabeth S Lim
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Nabil Wasif
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Patricia A Cronin
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chee-Chee Stucky
- Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Romitti M, Costagliola S. Progress Toward and Challenges Remaining for Thyroid Tissue Regeneration. Endocrinology 2023; 164:bqad136. [PMID: 37690118 PMCID: PMC10516459 DOI: 10.1210/endocr/bqad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
Thyroid hormones play a pivotal role in diverse physiological processes, and insufficient synthesis of these hormones results in hypothyroidism, a prevalent disorder with a significant global impact. Research has shown that the residual thyroid tissue following surgery fails to fully regenerate the gland and restore normal function. The slow turnover rate of the thyroid gland and the presence of resident stem cells, which may contribute to regeneration within adult thyroid tissue, are topics of ongoing debate. This comprehensive review summarizes current research findings concerning the regeneration of the adult thyroid. Investigations have identified potential cellular mechanisms implicated in thyroid regeneration following partial tissue damage, including cells within microfollicles and a cluster of potential thyroid progenitors cells. Nevertheless, the exact mechanisms remain elusive. In cases of complete removal of the thyroid gland, regeneration does not occur, underscoring the necessity for an external source of thyroid tissue. The transplantation of thyroid organoids has emerged as a promising approach to restore thyroid function. Researchers have successfully derived thyroid organoids from various sources and demonstrated their functionality in both in vitro and in vivo animal models. Despite the challenges that still need to be addressed in achieving full maturation and functionality of human thyroid organoids, significant strides have been made in this regard. This review explores the potential of thyroid organoid transplantation and its implications for the field of regenerative medicine.
Collapse
Affiliation(s)
- Mírian Romitti
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Sabine Costagliola
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| |
Collapse
|
8
|
Krajewska J, Kukulska A, Samborski K, Czarniecka A, Jarzab B. Lobo-isthmectomy in the management of differentiated thyroid cancer. Thyroid Res 2023; 16:4. [PMID: 36775829 PMCID: PMC9923929 DOI: 10.1186/s13044-022-00145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.
Collapse
Affiliation(s)
- Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102, Gliwice, Poland.
| | - Aleksandra Kukulska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland ,Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Konrad Samborski
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
| | - Agnieszka Czarniecka
- Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
| |
Collapse
|
9
|
Leong D, Gill AJ, Turchini J, Waller M, Clifton-Bligh R, Glover A, Sywak M, Sidhu S. The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma. World J Surg 2023; 47:412-420. [PMID: 36031639 DOI: 10.1007/s00268-022-06696-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Encapsulated angioinvasive follicular thyroid carcinoma (EAFTC) is associated with an increased risk of distant metastasis and reduced survival compared to minimally invasive follicular thyroid carcinoma (MIFTC). There is controversy regarding the extent of surgery and adjuvant radioactive iodine therapy for angioinvasive follicular thyroid carcinoma when stratified by number of foci of angioinvasion. METHODS All follicular thyroid carcinoma cases from 1990-2018 were identified from a thyroid cancer database. Primary outcomes were distant metastasis-free survival (DMFS) and disease-specific survival (DSS) with factors of interest being age, gender, tumour size, treatment, foci of angioinvasion and histological subtype. RESULTS A total of 292 cases were identified; 139 MIFTC, 141 EAFTC and 12 widely invasive follicular thyroid carcinoma (WIFTC). Over a follow-up period of 6.25 years, DMFS was significantly reduced (p < 0.001) with 14.2% (EAFTC) and 50% of WIFTC developing metastasis. The risk of metastasis in EAFTC with ≥ 4 foci of angioinvasion was 31.7% (HR = 5.89, p = 0.004), 6.3% for EAFTC with < 4 foci of angioinvasion (HR = 1.74, p = 0.47), compared to 3.6% MIFTC. Age ≥ 50 years (HR = 4.24, p = 0.005) and tumour size (HR = 1.27, p = 0.014) were significantly associated with increased risk of distant metastasis. DSS was reduced significantly (p < 0.001), with 7.8% EAFTC patients dying of disease. For EAFTC patients, DSS was 96.8% for < 4 foci and 82.6% for ≥ 4 foci of angioinvasion (p = 0.003). CONCLUSION EAFTC is at increased risk of distant metastasis related to the extent of angioinvasion. Tumours with < 4 foci of angioinvasion should be considered for a total thyroidectomy, particularly in older patients.
Collapse
Affiliation(s)
- David Leong
- Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia.
| | - Anthony J Gill
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - John Turchini
- Anatomical Pathology, Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia.,Discipline of Pathology, Macquarie Medical School, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Michael Waller
- Department of Biostatistics, School of Public Health, University of Queensland, Herston, QLD, 4006, Australia
| | - Roderick Clifton-Bligh
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia
| | - Anthony Glover
- Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Mark Sywak
- Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Stan Sidhu
- Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
10
|
Ullmann TM, Papaleontiou M, Sosa JA. Current Controversies in Low-Risk Differentiated Thyroid Cancer: Reducing Overtreatment in an Era of Overdiagnosis. J Clin Endocrinol Metab 2023; 108:271-280. [PMID: 36327392 PMCID: PMC10091361 DOI: 10.1210/clinem/dgac646] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Low-risk differentiated thyroid cancer (DTC) is overdiagnosed, but true incidence has increased as well. Owing to its excellent prognosis with low morbidity and mortality, balancing treatment risks with risks of disease progression can be challenging, leading to several areas of controversy. EVIDENCE ACQUISITION This mini-review is an overview of controversies and difficult decisions around the management of all stages of low-risk DTC, from diagnosis through treatment and follow-up. In particular, overdiagnosis, active surveillance vs surgery, extent of surgery, radioactive iodine (RAI) treatment, thyrotropin suppression, and postoperative surveillance are discussed. EVIDENCE SYNTHESIS Recommendations regarding the diagnosis of DTC, the extent of treatment for low-risk DTC patients, and the intensity of posttreatment follow-up have all changed substantially in the past decade. While overdiagnosis remains a problem, there has been a true increase in incidence as well. Treatment options range from active surveillance of small tumors to total thyroidectomy followed by RAI in select cases. Recommendations for long-term surveillance frequency and duration are similarly broad. CONCLUSION Clinicians and patients must approach each case in a personalized and nuanced fashion to select the appropriate extent of treatment on an individual basis. In areas of evidential equipoise, data regarding patient-centered outcomes may help guide decision-making.
Collapse
Affiliation(s)
- Timothy M Ullmann
- Division of General Surgery, Department of Surgery, Albany Medical College, 50 New Scotland Ave., MC-193, Albany, NY 12208, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 453S, Ann Arbor, MI 48109, USA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave. Ste. S320, Box 0104, San Francisco, CA 94143, USA
| |
Collapse
|
11
|
Stramazzo I, Capriello S, Antonelli A, Fallahi P, Centanni M, Virili C. Seeking optimization of LT4 treatment in patients with differentiated thyroid cancer. Hormones (Athens) 2022; 21:537-543. [PMID: 35655116 PMCID: PMC9712340 DOI: 10.1007/s42000-022-00376-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
Levothyroxine sodium (LT4) is the mainstay treatment to replace thyroid hormonal production in thyroidectomized patients, but, depending on the aggressiveness of the cancer and on the risk of recurrence, patients with differentiated thyroid cancer may also be treated in a TSH-suppressive or semi-suppressive mode. The pathophysiological rationale for this LT4 treatment stems from the role of TSH, considered to be a growth factor for follicular cells, potentially inducing initiation or progression of follicular cell-derived thyroid cancer. Therefore, accurate tailoring of treatment, taking into account both patient characteristics (age and comorbidities) and risk of persistent/recurrent disease, is highly recommended. Furthermore, adjustments to traditional LT4 treatment should be made in thyroidectomized patients due to the lack of thyroidal contribution to whole body triiodothyronine (T3) concentration. Since LT4 exhibits a narrow therapeutic index and the side effects of over- and under-treatment could be deleterious, particularly in this category of patients, caution is required in dose individualization, in the mode of ingestion, and in potential pharmacological and other types of interference as well. Our aim was to analyze the current knowledge concerning LT4 dose requirements in patients with thyroid cancer according to different therapeutic approaches, taking into account a number of factors causing interference with LT4 efficacy. Specific mention is also made about the use of the novel LT4 formulations.
Collapse
Affiliation(s)
- Ilaria Stramazzo
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
- Endocrine Unit, AUSL Latina, Latina, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy.
- Endocrine Unit, AUSL Latina, Latina, Italy.
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
| |
Collapse
|
12
|
Chen L, Yang X, Ren X, Lin Y. Reminiscence therapy care program as a potential nursing intervention to relieve anxiety, depression, and quality of life in older papillary thyroid carcinoma patients: A randomized, controlled study. Front Psychol 2022; 13:1064439. [PMID: 36507042 PMCID: PMC9729938 DOI: 10.3389/fpsyg.2022.1064439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Reminiscence therapy (RT) ameliorates psychological problems and quality of life in cancer patients. However, no study reports its effect on older papillary thyroid carcinoma (PTC) patients. This study intended to investigate the effect of the RT-care program (CP) on anxiety, depression, quality of life, and survival in older PTC patients. Methods Eighty-six postoperative older PTC patients were enrolled and randomly assigned to RT-CP group (N = 44) and usual (U)-CP group (N = 42) as a 1:1 ratio for a 6-month intervention. Hospital Anxiety and Depression Scale (HADS) and Quality of Life Questionnaire-Core 30 (QLQ-C30) scores were assessed at baseline, month (M)1, M2, M4, and M6. Results HADS and QLQ-C30 scores at baseline were not different between two groups. Additionally, HADS-anxiety score at M6 (p = 0.029), and HADS-depression score at M2 (p = 0.030), M4 (p = 0.029), M6 (p = 0.012) were reduced in RT-CP group versus U-CP group. Meanwhile, anxiety and depression rates from M1 to M6 were slightly decreased in RT-CP group versus U-CP group but did not reach statistical significance. Furthermore, depression severity at M6 was reduced in RT-CP group versus U-CP group (p = 0.049). Besides, QLQ-C30 global health status was increased at M2 (p = 0.023) and M6 (p = 0.033), QLQ-C30 function score was elevated at M2 (p = 0.040) and M4 (p = 0.035), while QLQ-C30 symptom score was decreased at M2 (p = 0.046) in RT-CP group versus U-CP group. Moreover, disease-free survival and overall survival were not different between two groups. Conclusion RT-CP may be a potential intervention for ameliorating anxiety, depression, and quality of life in older PTC patients.
Collapse
Affiliation(s)
- Li Chen
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xianguang Yang
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiukun Ren
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yufeng Lin
- Clean Operating Department, Harbin Medical University Cancer Hospital, Harbin, China,*Correspondence: Yufeng Lin,
| |
Collapse
|
13
|
Kim K, Choi JY, Kim SJ, Lee EK, Lee YK, Ryu JS, Lee KE, Moon JH, Park YJ, Cho SW, Park SK. Active Surveillance Versus Immediate Surgery for Low-Risk Papillary Thyroid Microcarcinoma Patients in South Korea: A Cost-Minimization Analysis from the MAeSTro Study. Thyroid 2022; 32:648-656. [PMID: 35570657 DOI: 10.1089/thy.2021.0679] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Active surveillance (AS) has been established as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC). Nonetheless, it remains difficult to decide between AS and immediate surgery, since limited objective evidence exists regarding risks and benefits. The aim of study is to compare the cumulative costs of AS and immediate surgery. Methods: To estimate cumulative costs, a hypothetical model is simulated based on the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Micro-Carcinoma (MAeSTro) study, a multicenter prospective cohort study of AS for PTMC. Direct and indirect costs are estimated from diagnosis to the treatment decision and follow-up for 10 years and a longer period. In the case of the scenarios, AS, AS to surgery due to changing their mind, and lobectomy (analyzed regardless of levothyroxine [LT4] treatment, as well as subdivided into lobectomy/LT4[-] and lobectomy/LT4[+]) are considered. A sensitivity analysis is performed using different discount rates to address uncertainties in future time costs. To compare the cumulative costs, we referred to previous research conducted in Hong Kong, the United States, and Japan. Results: The initial cost of AS is estimated to be 5.6 times lower than that of lobectomy (regardless of LT4 use), while the 10-year cumulative costs of AS ($2545) and lobectomy regardless of LT4 ($3045) are similar under a discount rate of 3%. However, in the long-term follow-up period, immediate surgery is going to be estimated more economical than AS. The costs of the two management approaches are similar in Hong Kong, but substantially different in the United States and Japan, implying that it could be affected by each country's national health insurance coverage and the thyroid ultrasound interval during follow-up. Conclusion: Considering both direct and indirect costs, the cumulative costs of AS and immediate surgery in low-risk PTMC patients are similar during 10 years, and surgery could be more economical for patients with a life expectancy in long-term follow-up. However, careful interpretation is needed for long-term follow-up and the country's health care system and environment. Nevertheless, considering the representative protocols and objective costs in South Korea, it is expected to be a key to suggest the appropriate treatment for PTMC patients.
Collapse
Affiliation(s)
- Kyungsik Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital & College of Medicine, Seoul, Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Young Ki Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Jun Sun Ryu
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital & College of Medicine, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital & College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital & College of Medicine, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Baran JA, Bauer AJ, Halada S, Mostoufi-Moab S, Isaza A, Robbins S, Franco AT, Adzick NS, Patel T, Kazahaya K. Clinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics. Thyroid 2021; 31:1786-1793. [PMID: 34714171 PMCID: PMC8721496 DOI: 10.1089/thy.2021.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Thyroid lobectomy reduces risks of surgical complications and need for levothyroxine (LT4). We aimed at identifying the clinical course and risk factors for postlobectomy hypothyroidism to optimize surgical counseling and management in pediatric patients undergoing lobectomy. Methods: Clinical and biochemical presentations pre- and postlobectomy were retrospectively reviewed for 110 patients who underwent thyroid lobectomy between 2008 and 2020 at the Children's Hospital of Philadelphia. Results: Approximately 28.2% of patients (31/110) developed postlobectomy hypothyroidism defined by an elevated thyrotropin (TSH) level, including 24.5% (27/110) with subclinical hypothyroidism (TSH >4.5 and <10.0 mIU/L) and 3.6% (4/110) with overt hypothyroidism (TSH >10.0 mIU/L). LT4 was initiated in 12.7% (14/110) of cases. Most patients (81.6%; 84/103) recovered euthyroidism within 12 months postlobectomy. When excluding patients with autonomous nodule(s), median preoperative TSH was 1.09 (interquartile range [IQR] = 0.70-1.77) mIU/L and 1.80 (IQR = 1.02-2.68) mIU/L in euthyroid and hypothyroid patients, respectively, with multivariate logistic regression confirming the association between an increased preoperative TSH and postlobectomy hypothyroidism (odds ratio = 1.8 [confidence interval 1.08-3.13], p = 0.024). Of the patients who underwent thyroid lobectomy and developed postoperative hypothyroidism (n = 31), 38.7% (12/31) had a preoperative diagnosis of an autonomously functioning thyroid nodule. Conclusions: Thyroid function should be evaluated postlobectomy to assess the need for LT4. LT4 should be considered if the TSH remains elevated, especially if an upward trend is observed or TSH is >10.0 mIU/L. Suppressed preoperative TSH associated with autonomous nodules is an independent risk factor for postlobectomy hypothyroidism.
Collapse
Affiliation(s)
- Julia A. Baran
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Stephen Halada
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
- Division of Pediatric Oncology; Philadelphia, Pennsylvania, USA
| | - Amber Isaza
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Stephanie Robbins
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Aime T. Franco
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | | | - Tasleema Patel
- Division of Endocrinology and Diabetes, The Thyroid Center; Philadelphia, Pennsylvania, USA
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Address correspondence to: Ken Kazahaya, MD, MBA, FAAP, FACS, Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 1 Wood Center/ENT, Philadelphia, PA 19104, USA
| |
Collapse
|
15
|
Haymart MR. Progress and Challenges in Thyroid Cancer Management. Endocr Pract 2021; 27:1260-1263. [PMID: 34562612 DOI: 10.1016/j.eprac.2021.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
The state of thyroid cancer in 2021 is reviewed including the prevalence of thyroid cancer, vulnerable patient groups such as women and young adults, and known and hypothesized risk factors for thyroid cancer. Understanding the overdiagnosis and overtreatment of thyroid cancer and recent efforts to reduce harms secondary to overdiagnosis and overtreatment are addressed with optimism that future work will continue to evaluate and improve the care of patients with thyroid cancer.
Collapse
Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
16
|
Risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in papillary thyroid carcinoma. Langenbecks Arch Surg 2021; 406:1223-1231. [PMID: 33970335 DOI: 10.1007/s00423-021-02189-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Thyroid lobectomy is now preferred over total thyroidectomy to preserve thyroid function and reduce complications in patients with low-risk papillary thyroid carcinoma (PTC). One inevitable consequence of thyroidectomy includes hypothyroidism. This study aimed to evaluate the risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in patients with PTC. METHODS We retrospectively studied 353 patients with PTC who underwent hemithyroidectomy with or without central neck dissection from January 2012 to January 2019. We excluded patients who had hypo- or hyperthyroidism preoperatively and those who underwent total or subtotal thyroidectomy. We analyzed various risk factors related to postoperative hypothyroidism and thyroid hormone supplementation. RESULTS Of the patients, 54.7% showed hypothyroidism after hemithyroidectomy (n=193 with n=157, subclinical hypothyroidism; n=36, overt hypothyroidism). Ninety-one percent of postoperative hypothyroidism cases developed within 7 months postoperatively. Eventually, 43.1% (n=152) of patients received levothyroxine after hemithyroidectomy. Preoperative high thyroid-stimulating hormone (TSH) level and low free thyroxine (fT4) level were significantly associated with postoperative hypothyroidism and the need for thyroid hormone supplementation postoperatively. CONCLUSION Preoperative TSH and fT4 levels are predictive risk factors of hypothyroidism and need for supplementation of levothyroxine after hemithyroidectomy in patients with PTC. Finally, approximately 43% of patients need levothyroxine supplementation after hemithyroidectomy, and individual preoperative counseling is necessary for these patients.
Collapse
|
17
|
Ma T, Wang H, Liu J, Zou J, Liu S. Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma? Front Endocrinol (Lausanne) 2021; 12:723631. [PMID: 34434171 PMCID: PMC8380921 DOI: 10.3389/fendo.2021.723631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe. METHODS Adult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group. RESULTS 370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16-85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%. CONCLUSION PTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.
Collapse
|