At 2 wk, 3 and 6 months, and afterward yearly serum TSH was monitored after surgery until the patient was lost to follow-up evaluation. Given the expected clinical heterogeneity, a random effects model was performed by default, and no fixed effects analyses were performed. We have moved to the new Hospital for Endocrine Surgery. In our meta-analysis, most of the detected thyroid dysfunction after hemithyroidectomy was subclinical hypothyroidism, although only four of the studies reported clear data on the distinction between subclinical and clinical hypothyroidism. Communication between the endocrinologist, surgeon, radiologists, and other members of the papillary thyroid cancer team is critical. The weighted pooled prevalence of hypothyroidism after hemithyroidectomy was 27% (95% CI, 2036). 2004 Jun;60(6):750-7. doi: 10.1111/j.1365-2265.2004.02050.x. Studies have shown that thyroid hormone replacement is needed ~40% of the time after a partial thyroidectomy (ie removal of one You listed the range for TgAB. After a partial thyroidectomy, your Tg should fall within the reference range for the test and remain relatively stable. In all studies, the majority of patients were female, with proportions ranging from 5896%. Before Of the patients who were preoperatively hyperthyroid, 60% of those with total thyroidectomy and all of those with subtotal thyroidectomy required L-T4 dose adjustments. 8600 Rockville Pike WebFollow-up of patients with differentiated thyroid cancers after thyroidectomy and radioactive iodine ablation. Psychological well-being in patients on adequate doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Hypothyroidism following thyroid nodulectomy: comparison with thyroid lobectomy: Es18p. Usually, its aim is to exclude malignancy in patients with solitary thyroid nodules with suspicious or indeterminate characteristics at fine-needle aspiration cytology (1). The present meta-analysis showed that the overall risk of hypothyroidism after hemithyroidectomy was 22%. Therefore, if the blood thyroid hormone levels are low, the TSH will be elevated and vice versa. Studies reporting on partial thyroidectomies were not included because that intervention can be more or less extended than hemithyroidectomy; including those studies could bias the estimated risk of hypothyroidism after hemithyroidectomy. Higher preoperative TSH level was a significant risk factor for hypothyroidism after hemithyroidectomy in 13 studies (3, 46, 54, 6065, 67, 68, 73, 74). We aimed to determine the risk of hypothyroidism after hemithyroidectomy in preoperatively euthyroid patients. Total thyroidectomy or lobectomy in benign nodular disease of the thyroid: changing trends in surgery. Long-term follow-up of contralateral lobe in patients hemithyroidectomized for solitary follicular adenoma. The changes in the thyroid gland after irradiation with 131I or partial thyroidectomy for thyrotoxicosis. Use and avoidance of continuity corrections in meta-analysis of sparse data. | Disclaimer | Become Our Patient. This search strategy was optimized for all consulted databases. In the individual patient, preoperative anti-TPO measurement may be used as a simple tool to estimate the risk of hypothyroidism in more detail before planning surgery. If your papillary thyroid cancer has been gone for a period of time and comes back, this is called recurrent papillary thyroid cancer. Rapid increase in volume of the remnant after hemithyroidectomy does not correlate with serum concentration of thyroid stimulating hormone. Secondly, no assumptions are needed for the exact approximation when dealing with zero-cells, whereas the standard approach needs to add an arbitrary value (often 0.5) when dealing with zero-cells, contributing to a biased estimate of the model (15). Collection Container/Tube:Red top (serum gel/SST are not acceptable). and transmitted securely. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. High TSH: is an indication of hypothyroidism. Detecting and defining hypothyroidism after hemithyroidectomy. If TgAb is positive, Tg is assayed by mass spectrometry (sensitive down to 0.2 ng/mL). The medication, which is necessary for maintaining a person's full health, must be taken on an empty stomach. If the authors did include preoperatively hypothyroid patients and did not provide data to calculate an incidence, the proportion of patients being hypothyroid postoperatively was defined as a prevalence. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine. Long-term suppression of TSH can result in low bone density and osteoporosis. Long-Term Adherence to Levothyroxine Replacement Therapy in Thyroidectomized Patients. During the first trimester of pregnancy, total T3 and T4 levels go up and TSH levels This is especially the case for proportions that are close to 0 or 1. Although subclinical hypothyroidism could have beneficial effects in the elderly (75), most patients undergoing hemithyroidectomy are under the age of 65 yr, and potential adverse consequences of subclinical hypothyroidism in middle-aged populations have been shown (9, 7678). This variation may be caused by different definitions of hypothyroidism, differences in patient characteristics between studied populations, follow-up duration, timing of thyroid hormone supplementation, and probably also surgical techniques. 2010 May;21 Suppl 5:v214-9. Hypothyroidism following hemithyroidectomy: a retrospective review. Prognosis of thyroid function after hemithyroidectomy. As our quantitative analysis implied, anti-TPO-positive patients had considerably higher risk (almost 50%) of hypothyroidism in comparison to anti-TPO-negative patients. Low calcium levels can cause many Exclusion of malignancy in thyroid nodules with indeterminate fine-needle aspiration cytology after negative 18F-fluorodeoxyglucose positron emission tomography: interim analysis. National Library of Medicine We know there is a lot of information on the site and it can be TSH can vary wildly based on your age, sex, and stage of life. Created for people with ongoing healthcare needs but benefits everyone. Drugs as common as vitamins with iron can do this. Data extraction from included studies was performed using a predefined extraction sheet, which was updated after a pilot test on five randomly selected relevant studies. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Bookshelf This site needs JavaScript to work properly. Prediction of hypothyroidism after partial thyroidectomy for thyrotoxicosis. HHS Vulnerability Disclosure, Help But what is most important is that those individuals which are following the papillary thyroid cancer patient are truly experts in the management, evaluation, and treatment of the disease. The pituitary-thyroid axis after hemithyroidectomy in euthyroid man. Bocale R, Desideri G, Barini A, D'Amore A, Boscherini M, Necozione S, Lombardi CP. The risk for hypothyroidism was clearly higher (48%; 95% CI, 4154) in patients with positive anti-TPO antibodies than in patients without antibodies (19%; 95% CI, 1327; P = 0.001). The aim of the present meta-analysis was to determine the overall risk of hypothyroidism after hemithyroidectomy in preoperatively euthyroid patients, as well as the risk of clinically relevant hypothyroidism. Ojomo KA, Schneider DF, Reiher AE, Lai N, Schaefer S, Chen H, Sippel RS. One study reported that in untreated hypothyroid patients, TSH levels progressively decreased during the first 20 months after surgery (46). In six studies, comprising 791 patients, the risk of hypothyroidism in patients with anti-TPO antibodies was compared with the risk in patients without these antibodies. In case it was unclear whether patients had hypothyroidism before the operation, the reported proportion was regarded to be a prevalence. Read our Thyroid Blog! 3) Ascertainment of exposure status at baseline. Vaiman et al. WebA total of 80.4% of physicians were likely or extremely likely to recommend TSH suppression for intermediaterisk papillary thyroid cancer, 48.8% recommended it for low-risk papillary The level may later change to 0.1 to 0.5, depending on your body's response to the treatment and time. Lipid and thyroid changes after partial thyroidectomy: guidelines for L-thyroxine therapy? Hypothyroidism can be accompanied by a range of clinical manifestations, negatively impacting health status (3). Exp Rev Endocrinol Metab. Above 10 ng/mL, the risk of residual/recurrent disease is at least 25%, with many studies showing 60% to >90% risks. A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules. WebAfter thyroidectomy for thyroid cancer, patients were often placed on levothyroxine doses that were high enough to suppress TSH levels to prevent recurrence of the cancer. A clear distinction between clinical (supranormal TSH levels and subnormal thyroid hormone levels) and subclinical (supranormal TSH levels and thyroid hormone levels within the normal range) hypothyroidism was provided in four studies. In patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.32mU=L). [Thyroid function after thyroidectomy for benign goiter. Results: Of the patients who were preoperatively euthyroid, 45% with total thyroidectomy, 42% with subtotal thyroidectomy, and 17% with hemithyroidectomy required L-T4 dose adjustments. A small majority of our preoperatively euthyroid patients received adequate therapy. Epub 2013 Jan 11. High rate of recurrence after lobectomy for solitary thyroid nodule. Normalization of thyroid function after a thyroid lobectomy may take a relatively long time period (49, 51, 59). If unstimulated (on thyroxine) serum Tg measurements are less than 0.1 to 0.2 ng/mL, the risk of disease is below 1%. The definition of hypothyroidism was based on criteria used by authors of included studies. An increased risk for hypothyroidism in patients with anti-thyroid peroxidase (anti-TPO) antibody positivity was consistently reported in six studies (56, 60, 64, 67, 68, 74). Jastrzebska H, Gietka-Czernel M, Zgliczyski S. Obstet Gynecol Surv. We are caring for patients from around the world. My name is Lisa. Helpful - 0 Comment Have an Answer? The American Thyroid Association Guidelines (2009) have more information and recommendations. This is the absolute foundation of the Thyroid Cancer Center. Small amounts of intact Tg are secreted alongside T4 and T3 and are detectable in the serum of healthy individuals, with levels roughly paralleling thyroid size (0.5-1.0 ng/mL Tg per gram thyroid tissue, depending on thyroid-stimulating hormone: TSH level). Detection and management of hypothyroidism following thyroid lobectomy: evaluation of a clinical algorithm. Comparison between thyroidectomy and hemithyroidectomy in treatment of single thyroid nodules identified as indeterminate follicular lesions by fine-needle aspiration cytology. Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. Herman Verloop, Marloes Louwerens, Jan W. Schoones, Job Kievit, Johannes W. A. Smit, Olaf M. Dekkers, Risk of Hypothyroidism following Hemithyroidectomy: Systematic Review and Meta-Analysis of Prognostic Studies, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 7, 1 July 2012, Pages 22432255, https://doi.org/10.1210/jc.2012-1063. First, the available data did not allow us to assess what proportion of the reported hypothyroidism is transient or permanent. Most patients will have a relatively low risk of recurrence and will thereafter only require unstimulated Tg measurement. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. If TgAb are detected, the laboratory report should alert the ordering provider to the possibility of false-low Tg results if using an immunometric assay. 1, the complete search strategy is shown. I am 46 years old. To make sure that your thyroid hormone levels in your blood are at the right level for you! Written by, Learn about our new home at the Hospital for Endocrine Surgerya dedicated endocrine surgery hospital with no COVID patients, ultrasound of the neck for papillary thyroid cancer. 2006 Aug;61(8):535-42. doi: 10.1097/01.ogx.0000228778.95752.66. Where possible, the pooled proportions where calculated separately for both clinical and subclinical hypothyroidism. Determined in a larger population, used as a surrogate for the actual hemithyroidectomized population included in this meta-analysis. The hospital is located 2.5 miles from the Tampa International Airport. Clin Endocrinol (Oxf). Overt and 'subclinical' hypothyroidism in women. Surgery for hyperthyroidism: hemithyroidectomy plus contralateral resection or bilateral resection? Levothyroxine replacement therapy after thyroid surgery. To determine whether all of your papillary thyroid cancer was completely removed. The primary outcome of this meta-analysis was defined as the risk of hypothyroidism after hemithyroidectomy, calculated by the number of patients developing hypothyroidism after hemithyroidectomy divided by the total number of operated patients. 2010 Nov;107(47):827-34. doi: 10.3238/arztebl.2010.0827. have nothing to declare. Furthermore, we aimed to identify risk factors for postoperative hypothyroidism. Study of the pituitary-thyroid axis in euthyroid goiter after partial thyroidectomy. If you have a question for our surgeons, 200 cases explored by ultrasensitive TSH]. Generally, it should not be taken with other drugs, since a large number of drugs interfere with thyroid hormone getting into the blood stream. They are linked from the web site in the sections titled Newly Diagnosed and Thyroid Cancer Types. Tg levels <0.1 ng/mL in athyrotic individuals on suppressive therapy indicate a minimal risk (<1%-2%) of clinically detectable recurrent papillary/follicular thyroid cancer. Prediction of hypothyroidism after hemithyroidectomy: a biochemical and pathological analysis. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen: Portions 2023 Mayo Foundation for Medical Education and Research. Questions or comments about our tests and resources? Disagreement on the screening or data extraction process was resolved by consensus after consulting a third reviewer (O.M.D.). For all proportions, exact confidence intervals (CI) were calculated. Corona Virus Update: Monday May 1, 2023. A stimulated Tg above 2 ng/mL is considered suspicious. PMC The papillary thyroid cancer patient follow-up can be performed by surgeons, endocrinologist, oncologists and others. Different assays and cutoff levels were used. These 31 publications reported on 32 cohorts. Thyrotropin level and thyroid volume for prediction of hypothyroidism following hemithyroidectomy in an Asian patient cohort. No restrictions on publication date were imposed, but only regular articles or letters to the editor including full data were considered for inclusion. Meta-analysis was performed using logistic regression with random effect at study level. TSH level in the higher-normal range and positive anti-TPO status are significant preoperative indicators of thyroid failure after surgery. Epub 2014 Jun 7. Lombardi CP, Bocale R, Barini A, Barini A, D'Amore A, Boscherini M, Bellantone R. Endocrine. Guberti et al. Whenever possible, a distinction was made between subclinical hypothyroidism [defined as free T4 (fT4), T3, or free T3 (fT3) levels within the normal range with increased TSH levels] and clinical hypothyroidism (defined as fT4, T3, or fT3 below the normal range as well as increased TSH levels) (9). In patients who have not undergone remnant ablation who are clinically free of disease and have undetectable suppressed serum Tg and normal neck ultrasound, the serum TSH may be allowed to rise to the low normal range (0.32mU=L). Study characteristics are summarized in Table 1. Solitary indeterminate follicular thyroid nodule, In all patients, thyroid function testing (TSH, fT, Dominant thyroid nodule (enlarging/suspicious nodule, 118 cases; compression symptoms, 10 cases; cosmetic concerns, 3 cases), Biochemical, based on elevated TSH level; cutoff level not reported, TSH measurement, not reported which time period after surgery, Most hypothyroid cases (84.5%) were detected at 1 or 6 months after surgery, Toxic multinodular goiter, nontoxic multinodular goiter, single nodule, Graves' disease, At least the incidence of hypothyroidism was determined within the first year after surgery, Solitary cold nodule in 33 cases, autonomous solitary nodule in 5 cases, and nontoxic goiter with compression in 7 cases, Biochemical, supranormal TSH levels (no reference range reported), FNA consistent with follicular/Hrthle cell neoplasm, 37 cases; progressive nodule growth +- compressive symptoms, 13 cases; persistently nondiagnostic FNA, 10 cases; exclusion of malignancy, 6 cases; incidental nodule, 4 cases; suppurative thyroiditis, 1 case, In all but two patients, hypothyroidism was diagnosed within 8 wk after surgery; two other patients were diagnosed 6 and 7 yr later, due to inadequate follow-up in one, In all patients at least 5 wk after surgery, a TSH measurement, More than 75% hypothyroid cases developed within 9 months; mean, 6.6 months, In all patients 8 to 10 wk after surgery, TSH measurement; subsequently every 34 months, TSH measurement, Incidence, 35/98 (35.7%); prevalence, 37/101 (36.6%), More than 75% of hypothyroid cases within 9 months, At least 2 months after surgery TSH measurement; thereafter every 23 months, for 1 yr in all patients, Benign nodular thyroid disease (progressive increase in nodule size; substernal extension; development of compressive symptoms; radiographic evidence of tracheal, esophageal, or vessel impingement; cosmetic concerns; thyrotoxicosis), Most likely biochemical, based on elevated TSH levels, 70% of patients initial TSH drawn first 3 months, 12% within 46 months, 12% within 712 months; 6% not in the first year, TSH >10 mIU/ml single measurement or 510 mIU/ml two consecutive measurements (interval, 68 wk), Majority (66%) diagnosed in the first year of follow-up, After surgery at 6 months interval TSH measurement, All but one of the 14 hypothyroid patients had been diagnosed so within 2 months, At least one TSH measurement drawn within 6 wk after surgery in all patients; furthermore, measurements were variable in all patients, Lobectomy for various indications including, goiter, follicular neoplasm, TSH >4.82 mIU/ml measured at least 6 wk after surgery, Malignant FNA, 1 case; recurrent cyst, 10 cases; solitary nodule, 145 cases; multinodular goiter, 138 cases, All 247 patients had preoperative TSH levels of 0.54.0 mIU/liter, 68% of hypothyroid cases were diagnosed by 6 months, 90% by 15 months, More than 90% hypothyroid cases within 6 months; 56/233 needed T, TSH measurement at least 46 wk after surgery; subsequently every 36 months for at least 3 yr, Serum TSH >6.0 mIU/liter at 6 months and more after surgery, Exclusion of malignancy and relief of compressive symptoms for unilateral thyroid mass, Clinical, 5.4 months (range, 36); subclinical, 12 months (612), TSH measurement once between 3 and 6 months after surgery, at 12 months, thereafter annually; T. Tuttle, RM: Serum thyroglobulin in the management of differentiated thyroid cancer. Grebe SKG: Diagnosis and management of thyroid carcinoma: a focus on serum thyroglobulin. Because Tg is thyroid-specific, serum Tg concentrations should be undetectable, or very low, after the thyroid gland is removed during treatment for thyroid cancer. The decision levels listed below are for thyroid cancer follow up of athyrotic patients and apply to unstimulated and stimulated thyroglobulin measurements. doi: 10.1093/annonc/mdq190. So our beautiful new home is also the safest place in the world to have your thyroid operation. Studies assessing thyroid function after hemithyroidectomy in euthyroid human populations of any age were eligible. WebA good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Patients on postoperative thyroid hormone substitution were considered to have subclinical or clinical hypothyroidism, even when a clear definition of hypothyroidism was not provided by the authors. Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease. Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre. Thus, there is a need to review conventional replacement therapy after thyroid surgery. Lindblom et al. J Am Coll Surg. The target TSH level for a low-risk patient is the same as for a healthy person who has a thyroid gland, 0.5 to 2.0 milliunits per liter (mU/L). Sometimes an initial level of 0.1 to 0.5 mU/L is acceptable, even though these numbers are mostly below the normal range. If they respond well to treatment, however, their goal may rise to the normal range. WebFifty-eight point three percent of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal 2 micro IU/ml developed hypothyroidism in comparison to only 17.1% of those with preoperative TSH <2 micro IU/ml (odds ratio 6.8). Should we treat all subjects with subclinical thyroid disease the same way? Updated July 15, 2021. : based on total population of 3470 patients who underwent partial thyroidectomy [subtotal thyroidectomy, near-total thyroidectomy, and hemithyroidectomy (n = 1051)]. Potentially relevant articles were read in full-text. In this meta-analysis, studies were performed in countries in which iodine status may vary. It is possible you may not require any thyroid hormone pill or supplement, however most papillary thyroid cancer patients during follow-up are maintained on thyroid hormone pills. In all cases, serum thyroglobulin autoantibodies (TgAb) should also be measured, preferably with a method that allows detection of low concentrations of TgAb. 2017 Jan;55(1):51-59. doi: 10.1007/s12020-016-1003-9. What constitutes adequate surgical therapy for benign nodular goiter? Studies not excluding patients with preoperative hypothyroidism or in which preoperative thyroid status was unknown were included; in a sensitivity analysis, studies with only preoperative euthyroid patients were analyzed. Albeit, later occurrences of hypothyroidism were possible (74). The normal range of TSH levels in non- pregnant adult women is 0.5 to 5.0 mIU/L. In a random-effects meta-regression, inclusion of consecutive patients (P = 0.90) or the explicit absence of loss to follow-up (P = 0.93) was not associated with the risk of hypothyroidism.