Thyroid-Stimulating Hormone Testing and Outcomes in Total Laryngectomy Patients

Assess timing and prevalence of thyroid-stimulating hormone (TSH) testing after total laryngectomy (TL). Identify prevalence of postoperative hypothyroidism and determine associations between thyroidectomy, postoperative hypothyroidism, and wound complications, including pharyngocutaneous fistula (PCF).

Retrospective chart review performed at 2 tertiary care centers of adult patients undergoing TL between 2013 and 2021. Demographic data, perioperative labs and post-operative outcomes were collected. Analysis was performed.

Of 237 patients identified, thyroid removal was performed in 156 (65.8%), including 23 (9.7%) total thyroidectomies and 133 (56.1%) hemi-thyroidectomies. Of the 191 (80.6%) receiving postoperative TSH testing, 98 (41.4%) had TSH testing within 90 days, and 112 (58.6%) developed hypothyroidism. Mean postoperative TSH testing interval was 222.0 days (SSD 400.2), with variations associated with age (P = .026), gender (P = .009), PCF formation (P < .001), history of radiation therapy (RT, P = .011), and preoperative levothyroxine use (P = .031). Partial or total thyroid removal significantly increased the likelihood of high postoperative TSH (OR = 2.631, P = .002, 95% CI [1.410, 4.911]). PCF occurred in 62 (26.2%) patients, and there were no significant associations between pre/postoperative TSH or thyroid removal and PCF development or wound complications.

Thyroidectomy was associated with elevated postoperative TSH levels, adding support to prior literature for consideration of avoiding thyroid removal during TL when appropriate. The wide range of TSH testing intervals and prevalence of postoperative hypothyroidism in our cohort highlights the importance of monitoring thyroid function in TL patients during the perioperative period.