Clinical Course of Early Postoperative Hypothyroidism Following Thyroid Lobectomy in Pediatrics

Area of Science:

• Pediatric Endocrinology
• Surgical Oncology
• Thyroidology

Background:

• Thyroid lobectomy is a surgical option that can reduce complications and the need for levothyroxine (LT4) replacement therapy.
• Understanding the clinical course and risk factors for post-lobectomy hypothyroidism is crucial for optimizing surgical counseling and management in pediatric patients.

Purpose of the Study:

• To identify clinical outcomes and risk factors associated with hypothyroidism after thyroid lobectomy in pediatric patients.
• To inform surgical counseling and post-operative management strategies.

Main Methods:

• Retrospective review of clinical and biochemical data for 110 pediatric patients who underwent thyroid lobectomy between 2008 and 2020.
• Analysis of pre- and post-lobectomy thyroid-stimulating hormone (TSH) levels, including subclinical and overt hypothyroidism.
• Multivariate logistic regression to identify risk factors, specifically preoperative TSH levels and the presence of autonomous nodules.

Main Results:

• Post-lobectomy hypothyroidism occurred in 28.2% of patients (31/110), with 24.5% experiencing subclinical and 3.6% overt hypothyroidism.
• Levothyroxine (LT4) was initiated in 12.7% of cases, and 81.6% of affected patients recovered euthyroidism within 12 months.
• Elevated preoperative TSH (median 1.80 vs 1.09 mIU/L) was associated with post-lobectomy hypothyroidism (OR=1.8, p=0.024). Autonomous functioning thyroid nodules were present in 38.7% of hypothyroid cases.

Conclusions:

• Thyroid function monitoring post-lobectomy is essential to detect hypothyroidism and guide levothyroxine (LT4) initiation.
• An upward trend in TSH or TSH >10.0 mIU/L warrants consideration for LT4 therapy.
• Elevated preoperative TSH, particularly in the context of autonomous nodules, is an independent risk factor for developing hypothyroidism after thyroid lobectomy.