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Updated: Aug 22, 2025
Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Abnormal TSH Prior to Surgery in Children with Graves' Disease Predicts Abnormal TSH Following Thyroidectomy
Inbal Hazkani1,2, Eli Stein2, Evan Edwards2
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Children with Graves' disease and hyperthyroidism before surgery, and Hispanic children, face higher risks of poor thyroid hormone replacement therapy compliance after total thyroidectomy. Early counseling is crucial for lifelong medication adherence.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Thyroid Disease Management
Background:
- Total thyroidectomy necessitates lifelong thyroid hormone replacement therapy.
- Ensuring patient compliance with medication is critical for successful treatment outcomes.
- Identifying factors associated with poor compliance is essential for improving pediatric care.
Purpose of the Study:
- To identify variables associated with poor compliance to thyroid hormone replacement therapy in children post-total thyroidectomy.
- To investigate predictors of thyroid-stimulating hormone (TSH) abnormalities in pediatric patients after thyroid surgery.
Main Methods:
- Retrospective cohort study of 100 pediatric patients (ages 3-20) undergoing total thyroidectomy.
- Poor compliance defined as ≥3 high TSH levels unrelated to radioactive iodine treatment.
- Multivariate regression analysis to identify associated variables.
Main Results:
- 42% of patients had ≥3 high TSH measurements; 29% were diagnosed with clinical hypothyroidism.
- No association found between sex, race, income, insurance, or etiology (benign vs. malignant) and adherence.
- Graves' disease, preoperative hyperthyroidism, and Hispanic ethnicity were associated with postoperative hypothyroidism (OR 9.38, p=0.004 and OR 6.15, p=0.033, respectively).
Conclusions:
- Preoperative hyperthyroidism in Graves' disease patients and Hispanic ethnicity predict postoperative TSH abnormalities.
- Comprehensive preoperative counseling on lifelong medication is necessary.
- Targeted interventions to improve adherence are needed for Graves' disease patients.
Objective:
To identify variables that are associated with poor compliance to thyroid hormone replacement therapy in children after total thyroidectomy.
Method:
A retrospective cohort study of children who underwent total thyroidectomy by high-volume pediatric otolaryngologists between 1/2014 and 9/2021. Postoperative poor compliance was characterized by at least three separate measurements of high TSH levels not associated with radioactive iodine treatment.
Results:
There were 100 patients, ages 3-20 years old who met inclusion criteria; 44 patients underwent thyroidectomy for cancer diagnosis, and 56 for Graves' disease. The mean follow-up time was 36.5 months (range 3.0-95.6 months). Overall, 42 patients (42%) were found to have at least three measurements of high TSH during follow-up, and 29 patients (29%) were diagnosed with clinical hypothyroidism. Sex, race, income, insurance type, and benign versus malignant etiology for thyroidectomy were not associated with adherence to therapy. Multivariate regression analysis identified patients with Graves' disease and hyperthyroidism at the time of surgery and Hispanic ethnicity to be associated with postoperative clinical hypothyroidism (OR 9.38, 95% CI 2.16-49.2, p = 0.004 and OR 6.15, 95% CI 1.21-36.0, p = 0.033, respectively).
Conclusions:
Preoperative hyperthyroidism in patients with Graves' disease and Hispanic ethnicity were predictors of postoperative TSH abnormalities. Preoperative counseling for patients and their families on the implications of total thyroidectomy and the need for life-long medications postoperatively is necessary. Efforts should be made to evaluate and improve adherence to therapy pre-and postoperatively in patients with Graves' disease.
Level Of Evidence:
4 Laryngoscope, 133:2402-2406, 2023.
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