Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram
| Autor: | Ziwen Liu, Mengwei Wu, Xiequn Xu, Rui Liu, Zhen Cao |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Oncology Thyroid Hormones endocrine system medicine.medical_specialty endocrine system diseases Hormone Replacement Therapy Endocrinology Diabetes and Metabolism Thyrotropin Nomogram Predictive nomogram Thyroid hormone replacement therapy Endocrinology Postoperative Complications Hypothyroidism Risk Factors Thyroid-stimulating hormone (TSH) Internal medicine Hemithyroidectomy Thyroid hormone replacement medicine Humans Thyroid Nodule Retrospective Studies business.industry Nomograms Thyroxine Thyroidectomy Female Original Article business |
| Zdroj: | Endocrine |
| DOI: | 10.21203/rs.3.rs-1026434/v1 |
| Popis: | Purpose Hemithyroidectomy is a valid operation to retain functional contralateral thyroid lobe that is indicated for a variety of thyroid diseases. This study aimed at determination of the risk factors for thyroid hormone replacement following hemithyroidectomy and to develop a predictive nomogram. Methods Data of patients treated by hemithyroidectomy for benign thyroid disease between January 2015 and January 2020 were retrospectively analyzed. Baseline characteristics, surgery-related variables, and preoperative and postoperative thyroid function of patients were collected from the case records and compared between patients with postoperative euthyroidism and patients with postoperative hypothyroidism. Postoperative euthyroidism patients without thyroid hormone replacement were compared to those who developed postoperative hypothyroidism with thyroid hormone replacement. The factors associated with thyroid hormone replacement were used to construct a binomial logistic-regression model and visualized as a predictive nomogram to evaluate the risk of thyroid hormone replacement following hemithyroidectomy. Results Of the 378 patients (74% female) included in the study, 110 (29.1%) developed postoperative hypothyroidism. Preoperative serum thyroid-stimulating hormone (TSH) > 2.172 µIU/mL was identified as an independent risk factor for postoperative hypothyroidism (odds ratio [OR] = 8.02; 95% confidence interval [CI]: 4.87-13.20; P < 0.001). Of 110 patients with postoperative hypothyroidism, 56 (50.9%) received thyroid hormone replacement. Unilateral thyroid nodule and preoperative serum TSH > 2.172 µIU/mL were independent predictors of postoperative thyroid hormone replacement (P = 0.01, and P < 0.001, respectively). Temporary subclinical hypothyroidism occurred in 12 patients; all 12 reverted to euthyroid state without thyroid hormone replacement. The discriminative effect of the binomial regression model was proved reliable by the Hosmer–Lemeshow goodness-of-fit test (P = 0.856), and predictive ability of the nomogram was satisfactory with a C-index of 0.85. Conclusion Hypothyroidism is common after hemithyroidectomy, and almost half of the patients will need thyroid hormone replacement. Elevated preoperative serum TSH level and unilateral thyroid nodule were independent predictors of thyroid hormone replacement following hemithyroidectomy. The predictive nomogram could be a useful tool for clinical practice. |
| Databáze: | OpenAIRE |
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