2015 American Thyroid Association guidelines and thyroid-stimulating hormone suppression after thyroid lobectomy
Robert Reed1, Andrew Strumpf1, Teresa G Martz2
1Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Head & Neck
|October 30, 2020
Summary
Most patients (76%) with well-differentiated thyroid cancer (WDTC) undergoing lobectomy require levothyroxine supplementation to meet 2015 American Thyroid Association (ATA) guidelines. Low preoperative thyroid-stimulating hormone (TSH) predicts lower postoperative TSH.
Area of Science:
- Endocrinology
- Oncology
- Surgical Oncology
Background:
- 2015 American Thyroid Association (ATA) guidelines suggest conservative management for low-risk well-differentiated thyroid cancer (WDTC), including lobectomy alone.
- These guidelines recommend mild thyroid-stimulating hormone (TSH) suppression (0.5-2 mU/L) for patients with WDTC treated with lobectomy.
Purpose of the Study:
- To assess the natural history of patients after lobectomy for WDTC.
- To determine the proportion of patients requiring postoperative levothyroxine supplementation to meet ATA guidelines.
Main Methods:
- Retrospective review of 168 patients who underwent lobectomy between 2010 and 2019.
- Analysis of preoperative and postoperative TSH levels and levothyroxine prescription rates.
Main Results:
- 35% of patients received levothyroxine postoperatively.
- 66% of patients had TSH >2 mU/L at 6 weeks post-surgery, rising to 76% by 6-12 months.
- Low preoperative TSH was the strongest predictor of postoperative TSH <2 mU/L.
Conclusions:
- Adherence to 2015 ATA guidelines for WDTC treated with lobectomy alone necessitates postoperative levothyroxine in the majority of patients (76%).
- Preoperative TSH levels are a significant factor in predicting the need for TSH suppression post-surgery.
