Department of Surgery, Baylor College of Medicine, Houston, Texas 77006, USA.
J Surg Res. 2013 Sep;184(1):189-92. doi: 10.1016/j.jss.2013.05.076. Epub 2013 Jun 11.
Thyroid nodules are exceedingly common, and the cytologic interpretation of fine needle aspiration (FNA) findings has been the reference standard for diagnosing nodules as benign, atypia or a follicular lesion of undetermined significance, suspicious for follicular or Hürthle cell neoplasm, suspicious for malignancy, or malignant. Many patients undergo thyroid lobectomy for indeterminate FNA findings (atypia or a follicular lesion of undetermined significance or suspicious for follicular or Hürthle cell neoplasm), although the risk of malignancy is low. The general data have quoted a 20% risk of hypothyroidism after lobectomy. The purpose of the present study was to determine the risk of hypothyroidism after lobectomy in our diverse population.
The pathology records from a large county hospital were reviewed to identify patients with indeterminate FNA findings. The incidence of hypothyroidism was determined by the need for thyroid hormone replacement therapy. Categorical variables were compared using the chi-square and continuous variables using the Mann-Whitney U test.
A total of 655 FNAs were performed during the study period, and 60 resulted in indeterminate cases. Of these 60 patients, 17 subsequently underwent diagnostic lobectomy. The mean age was 52.8 ± 16.5 years, 88% were women, and 67% were Hispanic and 22% were African American. Only 6% had a final diagnosis of cancer, and eight patients (47%) became hypothyroid postoperatively.
The incidence of hypothyroidism after diagnostic thyroid lobectomy in our patient population was much higher than previously reported. It is necessary to preoperatively counsel patients about this increased risk, in addition to the usual risks of nerve palsy and bleeding, with thyroid lobectomy. As testing of thyroid nodules evolves, the expense of preoperative testing should be weighed against the increased incidence for lifelong thyroid hormone replacement.
甲状腺结节非常常见，细针穿刺（FNA）细胞学检查结果一直是诊断结节为良性、不典型或滤泡性意义不明病变、疑似滤泡或 Hurthle 细胞肿瘤、疑似恶性或恶性的参考标准。许多患者因不确定的 FNA 结果（不典型或滤泡性意义不明病变或疑似滤泡或 Hurthle 细胞肿瘤）而行甲状腺叶切除术，尽管恶性肿瘤的风险较低。一般数据引用了甲状腺叶切除术后 20%的甲状腺功能减退风险。本研究旨在确定我们多样化人群中甲状腺叶切除术后甲状腺功能减退的风险。
回顾一家大型县医院的病理记录，以确定具有不确定的 FNA 结果的患者。通过需要甲状腺激素替代治疗来确定甲状腺功能减退症的发生率。使用卡方检验比较分类变量，使用 Mann-Whitney U 检验比较连续变量。
在研究期间共进行了 655 次 FNA，其中 60 次结果为不确定病例。在这 60 名患者中，有 17 名随后接受了诊断性甲状腺叶切除术。平均年龄为 52.8±16.5 岁，88%为女性，67%为西班牙裔，22%为非裔美国人。仅有 6%的最终诊断为癌症，8 名患者（47%）术后出现甲状腺功能减退。
在我们的患者人群中，诊断性甲状腺叶切除术后甲状腺功能减退的发生率远高于先前报道。除了甲状腺叶切除术常见的神经麻痹和出血风险外，术前还需要向患者告知这种风险增加的情况，此外，随着对甲状腺结节的检测不断发展，术前检测的费用应与终身甲状腺激素替代治疗的增加发生率进行权衡。
