Thyroid stimulating hormone suppression and recurrence after thyroid lobectomy for papillary thyroid carcinoma

Area of Science:

• Endocrinology
• Oncology
• Surgical Oncology

Background:

• Thyroid lobectomy is a standard treatment for low-risk thyroid cancer.
• Post-lobectomy hypothyroidism and recurrence necessitate thyroid hormone management.
• The 2015 American Thyroid Association (ATA) guidelines suggest thyroid-stimulating hormone (TSH) suppression after lobectomy.

Purpose of the Study:

• To evaluate the necessity of TSH suppression after thyroid lobectomy.
• To assess recurrence rates following thyroid lobectomy for unilateral papillary thyroid carcinoma (PTC).
• To identify predictors for post-lobectomy TSH suppression needs.

Main Methods:

• A cohort of 369 patients undergoing thyroid lobectomy and neck dissection for PTC was analyzed.
• Thyroid function tests were conducted pre- and post-operatively.
• Logistic regression identified factors predicting TSH suppression requirements based on 2015 ATA guidelines.

Main Results:

• TSH levels increased post-lobectomy, with a significant proportion exceeding 2 mIU/L.
• 45.5% of patients required levothyroxine (T4) supplementation.
• Preoperative TSH >2 mIU/L was the only independent predictor for post-lobectomy TSH suppression (P=0.003).
• Recurrence occurred in 1.1% of patients, all with TSH levels >2 mIU/L and without T4 supplementation.

Conclusions:

• Thyroid lobectomy for unilateral PTC demonstrates a low recurrence rate.
• Hypothyroidism is a significant risk following thyroid lobectomy.
• Preoperative TSH levels are predictive of the need for post-lobectomy TSH suppression according to 2015 ATA guidelines.