With long-term follow-up, nearly 50% of patients who underwent lobectomy required thyroid hormone replacement therapy, with nearly one-quarter not starting until ≥2 years after surgery, suggesting thyroid function should be followed for a minimum of 2 years.
Key Findings
Results
The rate of thyroid hormone replacement therapy after lobectomy was 46.8% over long-term follow-up.
110 of 235 patients required thyroid hormone replacement therapy (46.8%)
Study period was January 2005 to July 2010 at an academic institution
Median duration of follow-up was 7.2 years
The majority of patients were female (84.7%) with a mean age of 52 ± 1 years
97% of patients had benign pathology
Results
A substantial proportion of patients who required thyroid hormone replacement therapy did not begin it until ≥2 years after surgery.
24% of thyroid hormone replacement therapy patients started therapy ≥2 years after surgery
The mean time to thyroid hormone replacement therapy initiation was 621 days
The mean postoperative thyroid stimulating hormone level among those requiring replacement was 9.08 ± 0.96 mIU/L
This finding supports following thyroid function for a minimum of 2 years post-lobectomy
Results
Hashimoto thyroiditis was significantly associated with thyroid hormone replacement therapy use after lobectomy.
Hashimoto thyroiditis was diagnosed in 21.8% of patients who underwent thyroid hormone replacement therapy versus 8.0% of those without thyroid hormone replacement therapy
Odds ratio 3.2; 95% confidence interval, 1.43–6.79; P < .001 on univariate analysis
On multivariate analysis, only Hashimoto thyroiditis was independently associated with thyroid hormone replacement therapy use (odds ratio 2.88; 95% confidence interval, 1.3–6.6; P = .012)
There was no difference in age, sex, or malignancy between those who did and did not require thyroid hormone replacement therapy
Background
Previously reported rates of thyroid hormone replacement therapy after lobectomy vary considerably and have been limited by short-term follow-up.
Prior reported rates of thyroid hormone replacement therapy after lobectomy range from 15% to 48%
The authors note that existing studies are limited by short-term follow-up
The current study's long-term follow-up (median 7.2 years) yielded a rate of 46.8%, at the higher end of previously reported ranges
Conclusions
Patients undergoing thyroid lobectomy should be counseled about the likelihood of requiring thyroid hormone replacement therapy and should have thyroid function monitored for at least 2 years postoperatively.
Nearly 50% of lobectomy patients for benign disease required thyroid hormone replacement therapy in long-term follow-up
Nearly one-quarter of those requiring replacement did not start until ≥2 years after surgery
The decision to pursue lobectomy versus total thyroidectomy is described as 'highly individualized'
Authors recommend thyroid function be followed for a minimum of 2 years after lobectomy