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Thyroid stimulating hormone suppression and recurrence after thyroid lobectomy for papillary thyroid carcinoma

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Abstract

Background

Thyroid lobectomy is recommended as the primary treatment for low-risk thyroid cancer. However, recurrence and hypothyroidism may develop after lobectomy, necessitating thyroid hormone supplementation. The 2015 American Thyroid Association (ATA) guidelines recommended post-lobectomy thyroid-stimulating hormone (TSH) suppression. This study examined the need for TSH suppression and recurrence after lobectomy for unilateral papillary thyroid carcinoma (PTC).

Methods

This study involved 369 patients who underwent thyroid lobectomy and ipsilateral central neck dissection for PTC between 2007 and 2015. Thyroid function tests were performed before and regularly after lobectomy. Binary logistic regression analyses were used to find factors predictive of the post-lobectomy need for TSH suppression that was defined by the 2015 ATA guidelines.

Results

Serum TSH concentrations gradually increased after lobectomy: proportions with TSH >2 mIU/L at post-lobectomy 1, 3–6, 12, and 24 months were found in 77.0%, 82.3%, 66.7%, and 59.9%, respectively. After lobectomy, 168 (45.5%) patients received levothyroxine (T4) supplementation. Multivariate logistic regression analyses showed that pre-TSH level >2 mIU/L was the sole independent variable predictive of the need for post-lobectomy TSH suppression (P = 0.003). During the median follow-up of 72 months, recurrence was found in 4 (1.1%) patients who never received T4 supplementation and had post-lobectomy TSH levels >2 mIU/L.

Conclusions

Our data show that thyroid lobectomy for unilateral PTC is associated with a low recurrence rate, but a significant risk of hypothyroidism. Preoperative TSH level can predict the need for post-lobectomy TSH suppression compliant with the 2015 ATA guidelines.

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Author contributions

J.L.R. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: M.R.B., S.H.N., and J.L.R. Acquisition, analysis, or interpretation of data: M.R.B., S.H.N., J.L.R., S.H.C., S.H.N., and S.Y.K. Drafting of the paper: M.R.B., J.L.R. Critical revision of the paper for important intellectual content: M.R.B., S.H.N., and J.L.R. Statistical analysis: M.R.B., J.L.R. Administrative technical or material support: J.L.R., S.H.C., S.H.N., and S.Y.K. Supervision: J.L.R., S.H.C., and S.H.N.

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Authors and Affiliations

  1. Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Mi Rye Bae, Sung Hoon Nam, Seung-Ho Choi, Soon Yuhl Nam & Sang Yoon Kim

  2. Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea

    Jong-Lyel Roh

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  1. Mi Rye Bae
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Correspondence to Jong-Lyel Roh.

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Bae, M.R., Nam, S.H., Roh, JL. et al. Thyroid stimulating hormone suppression and recurrence after thyroid lobectomy for papillary thyroid carcinoma. Endocrine 75, 487–494 (2022). https://doi.org/10.1007/s12020-021-02911-x

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