OP102 – Assessing the need for post-operative Hormone Replacement Therapy (HRT): Preoperative factors predicting hypothyroidism after partial thyroidectomy

     

    Gauthier, Justin1; Wu, Susan2; Amajoyi, Robert3; Seitelman, Eric3; Datta, Rajiv3
    1 Department of Surgery, South Nassau Communities Hospital (SNCH), Long Island, NY, USA
    2 Pathology Department, SNCH, Long Island, NY, USA
    3 Gertrude & Louis Feil Cancer Center at SNCH, Valley Stream, LI, NY, USA

     

    Background: Patients undergoing thyroid lobectomy require preoperative counseling on the potential development of postoperative hypothyroidism and the need for subsequent lifetime thyroxine hormone replacement therapy [HRT]. Multiple pre-operative factors have been postulated to influence postoperative thyroid function including, but not limited to, thyroid stimulating hormone [TSH] and the presence of thyroiditis. Currently, preoperative TSH levels have been proven to best assess this risk, though no standardized guidelines for management exist. The goal of this study was to evaluate which factors best predict the need for HRT postoperatively.  By identifying these factors we hoped to assist the surgeon in preoperative counseling of patients undergoing partial thyroidectomy.

    Methods: This is a retrospective comparison of prospectively collected data from one hundred (100) thyroid specimens with a cohort of 67 patients being eligible for analysis.

    Results: Of the patients with pre-operative TSH levels <2.0mIU/L, nearly all (96.2%, 51/53) precluded post-operative hormone replacement therapy while those measuring  >2.5 mIU/L, required hormone replacement 100% of the time. For pre-operative levels between 2.0-2.5, though variable, patients had higher TSH on average in the HRT-requiring group (2.30) when compared to those spared of HRT (2.11). Furthermore, thyroiditis was more prevalent (6/9, 67%) in HRT group versus HRT-sparing (13/58, 22%).

    Conclusion: Preoperative TSH levels of >2.5, as well as the presence of thyroiditis, predicts risk of HRT postoperatively. Conversely, TSH <2.0 inversely correlates with need for post-operative HRT. Thus we propose that patients with elevated TSH, namely >2.5, should be offered total thyroidectomy in order to alleviate their surveillance requirement in a group destined for lifetime HRT regardless.

     

    References:

    1. Endocr Res. 2015;40(1):49-53. doi: 10.3109/07435800.2014.933975. Epub 2014 Aug 11.
      Factors associated with postoperative hypothyroidism after lobectomy in papillary thyroid microcarcinoma patients.
      Park HK1, Kim DW, Ha TK, Choo HJ, Park YM, Jung SJ, Kim DH, Bae SK.
    2. J Surg Res. 2015 Jan;193(1):273-8. doi: 10.1016/j.jss.2014.07.003. Epub 2014 Jul 5
      Prediction of thyroid hormone supplementation after thyroid lobectomy.
      Lee DY1, Seok J1, Jeong WJ1, Ahn SH2.
    3. Endocr Pract. 2013 Nov-Dec;19(6):1015-20. doi: 10.4158/EP12334.OR.
      Pre-operative ultrasound identification of thyroiditis helps predict the need for thyroid hormone replacement after thyroid lobectomy.
      Morris LF1, Iupe IM, Edeiken-Monroe BS, Warneke CL, Hansen MO, Evans DB, Lee JE, Grubbs EG, Perrier ND.
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