Thyroid Function After Hemithyroidectomy in Children
Authors' conclusion
Persistent hypothyroidism or LT4 treatment occurs in 27.5% of children within 5 years after hemithyroidectomy, usually in the first postoperative year. Preoperative TSH < 2 mIU/L may identify children at low risk, whereas preoperative TSH ≥ 2 mIU/L, particularly in conjunction with TPO antibodies, may identify children at high risk. Transient hypothyroidism also occurs commonly but may not require treatment. These data should inform preoperative counseling and postoperative monitoring around hemithyroidectomy in children.
Study context
- Population
- Consecutive pediatric patients (<19 years) who underwent hemithyroidectomy in a pediatric thyroid center, 1998–2023, with postoperative thyroid function and/or levothyroxine (LT4) data; 85% female, median age 15.4 years
- Participants
- 136 patients
- Outcome
- Composite of:
- Persistent hypothyroidism (TSH ≥ 5 mIU/L)
- LT4 treatment (PersHypo/LT4)
Methodological detailsconsecutive patients, single pediatric thyroid center, Median (IQR) follow-up 1.10 (0.15-3.2) years for thyroid function and 1.76 (0.38-4.3) years for LT4 status
- Consecutive patients
- Single pediatric thyroid center
- Median (IQR) follow-up 1.10 (0.15-3.2) years for thyroid function and 1.76 (0.38-4.3) years for LT4 status
Main finding
As reported in the abstract
- PersHypo/LT4 occurred
- 27/136 (20%)
- Estimated risk at 1 year
- 18.1% [CI: 12.1-26.6%]
- Estimated risk at 5 years
- 27.5% [CI: 18.7-39.2%]
- Occurred within 12 months
- 21/27 (78%)
- Occurred after 12 months
- 6/27 (22%)
Observational data: associations, not effects.
Secondary outcomes
PersHypo/LT4 association with preoperative TSH
- HR for preoperative TSH
- 1.89, [CI: 1.31-2.74], p = 0.001
- 5-year risk with preoperative TSH ≥ 2 mIU/L (high) vs low
- 58.8% vs 12.8%
- ROC AUC of TSH ≥ 2 mIU/L cutoff
- 0.73, [CI: 0.60-0.85]
PersHypo/LT4 association with thyroperoxidase (TPO) antibodies
- OR for TPO antibodies (independent)
- 7.37, [CI: 1.09-49.9], p = 0.041
Persistent hypothyroidism
- Occurred
- 14/128 (11%)
- Estimated 5-year risk
- 12.9% [CI: 7.7-21.1%]
Severe hypothyroidism
- Occurred
- 5/136 (3.7%)
Transient hypothyroidism
- Occurred
- 22/136 (16%)
Original publication
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