Clinical and biochemical predictors of postoperative thyroid hormone replacement requirement in long-term follow-up after thyroid lobectomy.

22.6% of patients required postoperative thyroid hormone replacement therapy following thyroid lobectomy.

• 367 patients who underwent thyroid lobectomy with or without isthmectomy between 2012 and 2024 were included.
• 83 of 367 patients (22.6%) required postoperative thyroid hormone replacement.
• Patients were followed postoperatively for an average duration of 45 months.
• This was a retrospective cohort study design.

A postoperative TSH level exceeding 2.53 µIU/mL at 6–8 weeks after surgery was an independent predictor of thyroid hormone replacement requirement.

• Multivariate analysis yielded an odds ratio of 1.125 (P = .03) for TSH >2.53 µIU/mL.
• ROC analysis showed a sensitivity of 78.95% and specificity of 71.76% for this TSH threshold.
• Area under the curve (AUC) was 0.786 (P < .001).
• TSH was measured at 6 to 8 weeks post-surgery.

Residual thyroid lobe volume of ≤5.234 cc was an independent predictor of postoperative thyroid hormone replacement requirement.

• Multivariate analysis yielded an odds ratio of 1.17 (P = .001) for residual lobe volume ≤5.234 cc.
• ROC analysis showed a sensitivity of 61.45% and a specificity of 74.30% for this volume threshold.
• AUC was 0.686 (P < .001).

Lymphocytic infiltration on pathological examination was an independent predictor of postoperative thyroid hormone replacement requirement.

• Multivariate analysis yielded an odds ratio of 2.624 (P = .003) for the presence of lymphocytic infiltration.
• Lymphocytic infiltration was identified on pathological examination of the surgical specimen.
• This was one of four independent predictors identified in the multivariate model.

Thyroiditis detected via preoperative ultrasound was an independent predictor of postoperative thyroid hormone replacement requirement.

• Multivariate analysis yielded an odds ratio of 3.771 (P = .001) for thyroiditis detected on preoperative ultrasound.
• This was the strongest predictor by odds ratio among the four independent predictors identified.
• Preoperative ultrasound findings were included as part of the collected data alongside thyroid function tests and pathological findings.

Four independent predictors of thyroid hormone replacement requirement after lobectomy were identified via multivariate analysis.

• The four predictors were: TSH >2.53 µIU/mL at 6–8 weeks post-surgery (OR: 1.125; P = .03), lymphocytic infiltration (OR: 2.624; P = .003), residual thyroid lobe volume ≤5.234 cc (OR: 1.17; P = .001), and thyroiditis on preoperative ultrasound (OR: 3.771; P = .001).
• Data collected included demographic information, preoperative and postoperative thyroid function test results, thyroid ultrasound findings, and pathological findings.
• The study authors suggest individualized preoperative assessment coupled with long-term follow-up may be useful in determining the necessity of hormone replacement therapy after lobectomy.