Banyi Norbert, Kwon Jamie J Y, Turkdogan Sena, Milner Thomas D, Prisman Eitan
Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Head Neck. 2024 Feb;46(2):249-261. doi: 10.1002/hed.27573. Epub 2023 Nov 11.
Hypothyroidism is common postlaryngectomy and is associated with laryngectomy-specific complications. The objective of this study is to determine the incidence and predictors of hypothyroidism postlaryngectomy and its associated complications.
Systematic review, data extraction, and meta-analyses were performed following the PRISMA protocol. Six databases were searched for studies reporting on postlaryngectomy thyroid status with incidence, risk factors, management, or complications.
Fifty-one studies with 6333 patients were included. The pooled incidence of postlaryngectomy hypothyroidism is 49% (CI 42%-57%). Subgroup analysis showed postlaryngectomy hypothyroidism rates significantly correlated with hemithyroidectomy and radiotherapy. Patients who underwent laryngectomy, hemithyroidectomy, and radiotherapy had a 65% (CI 59%-71%) rate of hypothyroidism; laryngectomy and hemithyroidectomy 46% (CI 33%-60%); laryngectomy and radiotherapy 26% (CI 19%-35%); and laryngectomy alone 11% (CI 4%-27%) (p < 0.001).
Laryngectomized patients with partial thyroidectomy or radiation therapy are at significant risk of postoperative hypothyroidism. Evidence-based protocols for early detection and (prophylactic) treatment should be established.
甲状腺功能减退在喉切除术后很常见，且与喉切除术后特有的并发症相关。本研究的目的是确定喉切除术后甲状腺功能减退的发生率、预测因素及其相关并发症。
按照PRISMA方案进行系统评价、数据提取和荟萃分析。检索了六个数据库，以查找报告喉切除术后甲状腺状态、发生率、危险因素、管理或并发症的研究。
纳入了51项研究，共6333例患者。喉切除术后甲状腺功能减退的合并发生率为49%（95%置信区间42%-57%）。亚组分析显示，喉切除术后甲状腺功能减退率与甲状腺半切术和放疗显著相关。接受喉切除术、甲状腺半切术和放疗的患者甲状腺功能减退率为65%（95%置信区间59%-71%）；接受喉切除术和甲状腺半切术的患者为46%（95%置信区间33%-60%）；接受喉切除术和放疗的患者为26%（95%置信区间19%-35%）；仅接受喉切除术的患者为11%（95%置信区间4%-27%）（p<0.001）。
接受部分甲状腺切除术或放疗的喉切除患者术后发生甲状腺功能减退的风险很高。应制定基于证据的早期检测和（预防性）治疗方案。
