Markedly Elevated Preoperative Thyroid-Stimulating Hormone Levels and Greater Operative Difficulty in Graves’ Disease: A Single-Center Cohort Study
Authors' conclusion
Preoperative TSH ≥ 10.0 μIU/mL was independently associated with greater blood loss and higher ERs in patients with GD who underwent total thyroidectomy. Avoiding iatrogenic hypothyroidism and marked TSH elevation during preoperative preparation may improve operative conditions.
Study context
- Population
- Consecutive patients with Graves' disease (GD) who underwent total thyroidectomy at a single center, 2009–20221,407 complete cases
- Participants
- 1,516 patients
- Exposure
- Preoperative thyroid-stimulating hormone (TSH) ≥ 10.0 vs < 10.0 μIU/mL
- TSH ≥ 10.0n = 48
- TSH < 10.0n = 1,359reference
- Outcome
- Intraoperative blood loss, enlargement ratio (ER; estimated preoperative/preadmission thyroid weight) and operative time
Methodological detailssingle-center, consecutive patients, complete case-cohort design
- Single-center
- Consecutive patients
- Complete case-cohort design
Main finding
As reported in the abstract
Intraoperative blood loss, ER and operative time
- Greater blood loss with TSH ≥ 10.0
- β (adjusted), blood loss 53.03 mL; P < 0.001
- Higher enlargement ratio (ER) with TSH ≥ 10.0
- β (adjusted), ER 0.12; P = 0.002
- Intraoperative blood loss, ER and operative time
- aOR, ER ≥ 1.1 2.60; P = 0.004
- Intraoperative blood loss, ER and operative time
- aOR, operative time ≥ 120 minutes 2.29; P = 0.018
Observational data: associations, not effects.
Secondary outcomes
Resected thyroid weight (unadjusted)
Preadmission TSH ≥ 10.0 μIU/mL · indicating earlier elevation
Original publication
Markedly Elevated Preoperative Thyroid-Stimulating Hormone Levels and Greater Operative Difficulty in Graves’ Disease: A Single-Center Cohort Study. Thyroid. Published 13 May 2026. doi:10.
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