Thyroid-Stimulating Hormone Testing and Outcomes in Total Laryngectomy Patients.

Area of Science:

• Otolaryngology
• Endocrinology
• Surgical Oncology

Background:

• Total laryngectomy (TL) is a surgical procedure for advanced laryngeal cancer.
• Thyroid gland manipulation or removal during TL can impact thyroid function.
• Postoperative thyroid dysfunction requires careful monitoring and management.

Purpose of the Study:

• To assess the timing and prevalence of thyroid-stimulating hormone (TSH) testing after TL.
• To determine the incidence of postoperative hypothyroidism.
• To investigate associations between thyroidectomy, hypothyroidism, and wound complications like pharyngocutaneous fistula (PCF).

Main Methods:

• Retrospective chart review of adult patients undergoing TL at two tertiary care centers (2013-2021).
• Collection of demographic data, perioperative laboratory results, and postoperative outcomes.
• Statistical analysis to identify associations and significant factors.

Main Results:

• Thyroid removal occurred in 65.8% of 237 patients; 56.1% underwent hemi-thyroidectomy.
• Postoperative hypothyroidism developed in 58.6% of patients tested.
• Elevated postoperative TSH was significantly associated with partial or total thyroid removal (OR=2.631).
• Mean TSH testing interval was 222 days, with significant variations based on age, gender, PCF, radiation history, and levothyroxine use.

Conclusions:

• Thyroidectomy during TL is associated with increased postoperative TSH levels.
• The study highlights the importance of thyroid function monitoring in TL patients due to delayed testing and high hypothyroidism rates.
• Avoiding thyroid removal during TL, when clinically appropriate, may be considered.