Changes in serum lipid profile after total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer patients

Serum lipids have been suggested to be associated with thyroid dysfunction in papillary thyroid carcinoma (PTC) patients after thyroidectomy. However, the association of lipids with different surgeries remains unclear. This study aimed to examine lipids changes after different surgeries in PTC patients.

This longitudinal cohort study enrolled 298 patients diagnosed with PTC who underwent surgery and were followed up routinely, from January 1, 2020 to December 31, 2023. Thyroid functions and fasting serum lipids were evaluated at baseline, 1, 3, 6, 12, 18, 24, 30 and 36 months of follow-up. A mixed-effect linear regression model was used to compare postoperative serum lipids with different surgery groups adjusted for baseline confounders.

A total of 435 postoperative measurements of serum lipids were included in the analysis. Compared with total thyroidectomy (TT) (n=144, 48.32%), thyroid lobectomy (TL) (n=154, 51.68%) was associated with decreased postoperative triglyceride [β=-0.255, 95% confidence interval (CI): -0.451 to -0.058] and increased high-density lipoprotein (HDL; β=0.098, 95% CI: 0.013 to 0.182), but not with total cholesterol, low-density lipoprotein (LDL), lipoprotein(a) and small dense low-density lipoprotein cholesterol (sd-LDL-C). The association with triglyceride was more pronounced in shorter follow-up (≤12 months) (β=-0.266, 95% CI: -0.497 to -0.035) vs. longer follow-up (>12 months) (β=-0.155, 95% CI: -0.563 to 0.253). Association with HDL was more pronounced in longer follow-up (β=0.172, 95% CI: 0.003 to 0.341) vs. shorter follow-up (β=0.030, 95% CI: -0.050 to 0.110).

This study suggests that different surgeries can independently affect postoperative serum lipids in PTC patients. Patients who underwent TT had worse lipid changes than TL. These changes indicate an increased risk for cardiovascular outcomes among patients with TT, which calls for more postoperative monitoring.