Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Endocrinol (Lausanne). 2021 Feb 9;11:619841. doi: 10.3389/fendo.2020.619841. eCollection 2020.
Management strategies after lobectomy for low-risk papillary thyroid carcinoma (PTC) are controversial. This study aimed to identify the proportion of patients among low-risk PTC patients who do not require hormone replacement therapy and to evaluate the risk factors for postoperative hypothyroidism after lobectomy.
The records of 190 PTC patients who underwent thyroid lobectomy from January 2017 to December 2018 were retrospectively reviewed. Clinicopathological characteristics and follow-up data were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with postoperative hypothyroidism and the recovery of thyroid function.
In summary, 74.21% of patients (141/190) had normal thyroid function without levothyroxine supplementation, while 40.53% (77/190) developed temporary or permanent hypothyroidism. Multivariate analysis indicated that higher preoperative thyroid-stimulating hormone (TSH) levels (>2.62 mIU/L), Hashimoto's thyroiditis (HT), and right lobectomy were associated with hypothyroidism (all P<0.05). The Area Under Curve (AUC) by logistic analysis was 0.829. Twenty-eight (28/77, 36.4%) patients recovered to the euthyroid state in the first year after surgery, and this recovery was significantly associated with preoperative TSH level. Forty-nine (49/77, 63.6%) patients developed persistent hypothyroidism. The thyroid function of most patients (11/28, 39.3%) recovered in the third month after surgery.
Patients with a lower level of preoperative TSH, with left lobectomy and without Hashimoto's thyroiditis had a higher chance of normal thyroid function within the first year after lobectomy. The recovery of thyroid function was associated with the level of preoperative TSH.
甲状腺叶切除术后低危型甲状腺乳头状癌（PTC）的管理策略存在争议。本研究旨在确定低危型 PTC 患者中无需激素替代治疗的患者比例，并评估甲状腺叶切除术后发生甲状腺功能减退的危险因素。
回顾性分析了 2017 年 1 月至 2018 年 12 月期间 190 例接受甲状腺叶切除术的 PTC 患者的记录。收集了临床病理特征和随访数据。进行了单因素和多因素分析，以确定与术后甲状腺功能减退和甲状腺功能恢复相关的危险因素。
总结而言，74.21%（141/190）的患者甲状腺功能正常，无需左甲状腺素补充，而 40.53%（77/190）发生暂时性或永久性甲状腺功能减退。多因素分析表明，术前甲状腺刺激激素（TSH）水平较高（>2.62 mIU/L）、桥本甲状腺炎（HT）和右叶切除术与甲状腺功能减退相关（均 P<0.05）。逻辑分析的曲线下面积（AUC）为 0.829。28 例（28/77，36.4%）患者在术后第一年恢复到甲状腺功能正常状态，这种恢复与术前 TSH 水平显著相关。49 例（49/77，63.6%）患者发生持续性甲状腺功能减退。大多数患者（11/28，39.3%）的甲状腺功能在术后第三个月恢复。
术前 TSH 水平较低、行左叶切除术且无桥本甲状腺炎的患者，在甲状腺叶切除术后第一年甲状腺功能正常的可能性更高。甲状腺功能的恢复与术前 TSH 水平有关。
