Sato Shinya, Nagayama Yuji, Shindo Hisakazu, Katsuyama Kento, Tatsushima Daisuke, Mori Yusuke, Takahashi Hiroshi, Tachibana Seigo, Fukuda Takashi, Yamashita Hiroyuki
Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan.
Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka, Japan.
Endocr Res. 2025 Sep 11:1-8. doi: 10.1080/07435800.2025.2556056.
Postoperative hypothyroidism, a complication of thyroid lobectomy, occurs frequently. Unique cases of post-lobectomy painless thyroiditis, a pathology not previously reported, were recently observed in our practice. In this study, we aimed to retrospectively investigate the frequency and characteristics of thyroid dysfunction after lobectomy, focusing on painless thyroiditis.
A total of 193 patients with thyroid tumors, including 66 with Hashimoto's thyroiditis and 127 without Hashimoto's thyroiditis, underwent thyroid lobectomy. These patients were followed up for 49.6 (12-118) months.
Thyroid dysfunction occurred in 20.7% of patients, including 31.8% (21/66) and 14.9% (19/127) of those with and without Hashimoto's thyroiditis, respectively. The types of thyroid dysfunction included thyrotoxicosis (10.0%), subclinical hypothyroidism (47.5%), and overt hypothyroidism (42.5%). Nine of 21 patients with Hashimoto's thyroiditis who developed thyroid dysfunction 1-4 months after lobectomy were diagnosed with painless thyroiditis, based on the characteristic transient hypoechogenic pattern on ultrasonography during hormonal fluctuations. Four patients developed thyrotoxicosis, one of whom subsequently become hypothyroid. Thyroid function returned to normal in all four patients. Two patients tested negative for TSH receptor antibody during the thyrotoxic period. The remaining five patients developed hypothyroidism, which was transient in three patients.
Painless thyroiditis develops as post-lobectomy thyroid dysfunction in patients with Hashimoto's thyroiditis. We propose naming this condition "post-lobectomy thyroiditis," as it is believed to be triggered by surgical manipulation of the thyroid gland in individuals with underlying subclinical thyroid autoimmunity. Given its transient nature in most cases, distinguishing this condition from postoperative permanent hypothyroidism is essential.
术后甲状腺功能减退是甲状腺叶切除术常见的并发症。我们在临床实践中最近观察到了叶切除术后无痛性甲状腺炎的独特病例，这是一种此前未报道过的病理情况。在本研究中，我们旨在回顾性调查甲状腺叶切除术后甲状腺功能障碍的发生率和特征，重点关注无痛性甲状腺炎。
共有193例甲状腺肿瘤患者接受了甲状腺叶切除术，其中66例患有桥本甲状腺炎，127例未患桥本甲状腺炎。这些患者接受了49.6（12 - 118）个月的随访。
20.7%的患者出现甲状腺功能障碍，其中患有和未患桥本甲状腺炎的患者分别为31.8%（21/66）和14.9%（19/127）。甲状腺功能障碍的类型包括甲状腺毒症（10.0%）、亚临床甲状腺功能减退（47.5%）和显性甲状腺功能减退（42.5%）。21例术后1 - 4个月出现甲状腺功能障碍的桥本甲状腺炎患者中，有9例根据激素波动期间超声检查特征性的短暂低回声模式被诊断为无痛性甲状腺炎。4例患者出现甲状腺毒症，其中1例随后发展为甲状腺功能减退。所有4例患者的甲状腺功能均恢复正常。2例患者在甲状腺毒症期促甲状腺激素受体抗体检测呈阴性。其余5例患者出现甲状腺功能减退，其中3例为短暂性。
无痛性甲状腺炎在桥本甲状腺炎患者中表现为叶切除术后甲状腺功能障碍。我们建议将这种情况命名为“叶切除术后甲状腺炎”，因为它被认为是由潜在亚临床甲状腺自身免疫个体的甲状腺手术操作引发的。鉴于其在大多数情况下的短暂性，将这种情况与术后永久性甲状腺功能减退区分开来至关重要。
