Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Laryngoscope. 2023 Sep;133(9):2402-2406. doi: 10.1002/lary.30485. Epub 2022 Nov 12.
To identify variables that are associated with poor compliance to thyroid hormone replacement therapy in children after total thyroidectomy.
A retrospective cohort study of children who underwent total thyroidectomy by high-volume pediatric otolaryngologists between 1/2014 and 9/2021. Postoperative poor compliance was characterized by at least three separate measurements of high TSH levels not associated with radioactive iodine treatment.
There were 100 patients, ages 3-20 years old who met inclusion criteria; 44 patients underwent thyroidectomy for cancer diagnosis, and 56 for Graves' disease. The mean follow-up time was 36.5 months (range 3.0-95.6 months). Overall, 42 patients (42%) were found to have at least three measurements of high TSH during follow-up, and 29 patients (29%) were diagnosed with clinical hypothyroidism. Sex, race, income, insurance type, and benign versus malignant etiology for thyroidectomy were not associated with adherence to therapy. Multivariate regression analysis identified patients with Graves' disease and hyperthyroidism at the time of surgery and Hispanic ethnicity to be associated with postoperative clinical hypothyroidism (OR 9.38, 95% CI 2.16-49.2, p = 0.004 and OR 6.15, 95% CI 1.21-36.0, p = 0.033, respectively).
Preoperative hyperthyroidism in patients with Graves' disease and Hispanic ethnicity were predictors of postoperative TSH abnormalities. Preoperative counseling for patients and their families on the implications of total thyroidectomy and the need for life-long medications postoperatively is necessary. Efforts should be made to evaluate and improve adherence to therapy pre-and postoperatively in patients with Graves' disease.
4 Laryngoscope, 133:2402-2406, 2023.
确定与儿童全甲状腺切除术后甲状腺激素替代治疗依从性差相关的变量。
对 2014 年 1 月至 2021 年 9 月间由高容量儿科耳鼻喉科医生进行全甲状腺切除术的儿童进行回顾性队列研究。术后依从性差的特征为至少有三次与放射性碘治疗无关的高 TSH 水平的单独测量值。
共有 100 名符合纳入标准的 3-20 岁患者；44 例因癌症诊断而行甲状腺切除术，56 例因格雷夫斯病而行甲状腺切除术。平均随访时间为 36.5 个月（范围 3.0-95.6 个月）。总的来说，42 名患者（42%）在随访期间至少有三次 TSH 升高的测量值，29 名患者（29%）被诊断为临床甲状腺功能减退症。性别、种族、收入、保险类型、甲状腺切除术的良性与恶性病因与治疗依从性无关。多变量回归分析发现，手术时患有格雷夫斯病和甲状腺功能亢进症以及西班牙裔的患者与术后临床甲状腺功能减退症相关（OR 9.38，95%CI 2.16-49.2，p=0.004 和 OR 6.15，95%CI 1.21-36.0，p=0.033）。
格雷夫斯病患者术前甲状腺功能亢进症和西班牙裔是术后 TSH 异常的预测因素。对患者及其家属进行关于全甲状腺切除术的影响以及术后终身药物治疗必要性的术前咨询是必要的。应努力评估和改善格雷夫斯病患者术前和术后的治疗依从性。
4 级喉镜，133：2402-2406，2023 年。
