Reckziegel Ramona Paula Fernandes, Golbert Lenara, Meyer Erika Laurini de Souza
Endocrinology Service, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil.
Int Arch Otorhinolaryngol. 2025 Apr 15;29(2):1-6. doi: 10.1055/s-0045-1801852. eCollection 2025 Apr.
Hemithyroidectomy is performed for the treatment of symptomatic unilateral benign nodules, cytologically indeterminate nodules, and some cases of well-differentiated thyroid cancer. To evaluate the frequency of postlobectomy thyroid hormone replacement (THR), and to analyze the clinical-pathological factors predicting L-thyroxine (T4) use in patients undergoing hemithyroidectomy. We conducted an observational, retrospective study in which clinical, biochemical, and anatomopathological parameters were analyzed and correlated with the need for THR after thyroid lobectomy. The frequency of postoperative THR was 63%. The preoperative thyroid-stimulating hormone (TSH) level was an important predictor of postoperative THR. When stratifying preoperative TSH levels, the frequencies of T4 replacement in each TSH quartile varied, being more frequent with increasing presurgical TSH levels ( = 0.029). The preoperative cutoff that maximized sensitivity and specificity for the development of hypothyroidism was 1.21 μIU/mL. Our results demonstrated a significant frequency of postlobectomy THR. Higher preoperative TSH is a strong risk factor for postsurgical hypothyroidism, and even lower preoperative levels within the normal references do not exclude the risk of thyroid hormone use after thyroid lobectomy.
甲状腺半切除术用于治疗有症状的单侧良性结节、细胞学检查结果不确定的结节以及某些分化型甲状腺癌病例。为了评估甲状腺叶切除术后甲状腺激素替代治疗（THR）的频率，并分析预测甲状腺半切除术患者使用左甲状腺素（T4）的临床病理因素。我们进行了一项观察性回顾性研究，分析临床、生化和解剖病理学参数，并将其与甲状腺叶切除术后THR的需求进行关联。术后THR的频率为63%。术前促甲状腺激素（TSH）水平是术后THR的重要预测指标。对术前TSH水平进行分层时，每个TSH四分位数中T4替代的频率各不相同，术前TSH水平越高，T4替代越频繁（P = 0.029）。对于甲状腺功能减退症发生时灵敏度和特异性最大化的术前临界值为1.21 μIU/mL。我们的结果表明甲状腺叶切除术后THR的频率较高。术前TSH水平较高是术后甲状腺功能减退症的一个强风险因素，即使术前水平在正常参考范围内较低也不能排除甲状腺叶切除术后使用甲状腺激素的风险。
