Lecturer of Department of Surgery, University of Malaya, Malaysia.
Department of Surgery, University of Malaya, Malaysia.
Asian J Surg. 2019 Nov;42(11):957-962. doi: 10.1016/j.asjsur.2019.01.015. Epub 2019 Apr 12.
Hemithyroidectomy has a known but less predictable sequelae of hypothyroidism. Presence of anti-thyroid antibody is known, well studied risk factor. Other postulated risk factors include higher pre-operative TSH level and lower ratio of post-operative thyroid remnant to the patient's weight. We reviewed our data to address the above mentioned risk factors.
This was a retrospective study done in National Cheng Kung University Hospital, Taiwan from 2015 to 2017. 125 patients underwent hemithyroidectomy, but 24 patients were excluded due to autoimmune thyroiditis, which was determined as the exclusion criteria. Standard panel of blood investigations were taken in each clinic visit before and after operation. A neck ultrasound was done 2 months post-operatively to assess the thyroid remnant. Chi-square test was used for categorical data analysis. Independent student t-test was used for continuous data with parametric distribution and Mann-Whitney U test for non parametric data. p < 0.05 was taken as statistically significant.
The mean duration of follow up was 29.3 months. 4 out of 101 patients had clinical hypothyroidism; 23 patients developed subclinical hypothyroidism post-hemithyroidectomy. 6 patients of subclinical hypothyroidism had spontaneously recovered within 1 year. Pre-operative TSH >2.0 uIU/mL was a risk factor as Chi square test showed p < 0.001. However, thyroid remnants were found not to be a risk factor with the Mann-Whitney U test of p = 0.928.
Minimum 1 year of follow up for hemithyroidectomy patients was suggested in order not to miss patients developing hypothyroidism post-operatively.
甲状腺次全切除术有一个已知但预测性较差的甲状腺功能减退症的后遗症。抗甲状腺抗体的存在是一个已知的、研究充分的危险因素。其他推测的危险因素包括术前 TSH 水平较高和术后甲状腺残余物与患者体重的比值较低。我们回顾了我们的数据，以解决上述危险因素。
这是一项在台湾成大医院进行的回顾性研究，时间为 2015 年至 2017 年。125 例患者接受了甲状腺次全切除术，但由于自身免疫性甲状腺炎，有 24 例患者被排除在外，这被确定为排除标准。在每次就诊前和手术后都进行了标准的血液检查。术后 2 个月进行颈部超声检查以评估甲状腺残余物。卡方检验用于分类数据分析。连续数据采用参数分布的独立样本 t 检验，非参数数据采用 Mann-Whitney U 检验。p<0.05 为统计学意义。
平均随访时间为 29.3 个月。101 例患者中有 4 例出现临床甲状腺功能减退症；甲状腺次全切除术后 23 例发生亚临床甲状腺功能减退症。6 例亚临床甲状腺功能减退症患者在 1 年内自发恢复。术前 TSH>2.0 uIU/mL 是一个危险因素，卡方检验显示 p<0.001。然而，用 Mann-Whitney U 检验，甲状腺残余物不是一个危险因素，p=0.928。
建议对甲状腺次全切除术患者进行至少 1 年的随访，以避免漏诊术后发生甲状腺功能减退症的患者。
