title: Thyroid lobectomy for indeterminate FNA: not without consequences.
abstract: BACKGROUND
  Thyroid nodules are exceedingly common, and the cytologic interpretation of fine needle aspiration (FNA) findings has been the reference standard for diagnosing nodules as benign, atypia or a follicular lesion of undetermined significance, suspicious for follicular or Hürthle cell neoplasm, suspicious for malignancy, or malignant. Many patients undergo thyroid lobectomy for indeterminate FNA findings (atypia or a follicular lesion of undetermined significance or suspicious for follicular or Hürthle cell neoplasm), although the risk of malignancy is low. The general data have quoted a 20% risk of hypothyroidism after lobectomy. The purpose of the present study was to determine the risk of hypothyroidism after lobectomy in our diverse population.
  
  
  METHODS
  The pathology records from a large county hospital were reviewed to identify patients with indeterminate FNA findings. The incidence of hypothyroidism was determined by the need for thyroid hormone replacement therapy. Categorical variables were compared using the chi-square and continuous variables using the Mann-Whitney U test.
  
  
  RESULTS
  A total of 655 FNAs were performed during the study period, and 60 resulted in indeterminate cases. Of these 60 patients, 17 subsequently underwent diagnostic lobectomy. The mean age was 52.8 ± 16.5 years, 88% were women, and 67% were Hispanic and 22% were African American. Only 6% had a final diagnosis of cancer, and eight patients (47%) became hypothyroid postoperatively.
  
  
  CONCLUSIONS
  The incidence of hypothyroidism after diagnostic thyroid lobectomy in our patient population was much higher than previously reported. It is necessary to preoperatively counsel patients about this increased risk, in addition to the usual risks of nerve palsy and bleeding, with thyroid lobectomy. As testing of thyroid nodules evolves, the expense of preoperative testing should be weighed against the increased incidence for lifelong thyroid hormone replacement.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas 77006, USA. cb131098@bcm.tmc.edu
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Robert P
authors.initials: RP
authors.lastname: Domingo
authors.forename: Rishi
authors.initials: R
authors.lastname: Patel
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Laucirica
authors.forename: James W
authors.initials: JW
authors.lastname: Suliburk
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018249:Adenoma, Oxyphilic; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013963:Thyroid Hormones / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D013966:Thyroiditis / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D013963:Thyroid Hormones
keywords: Hypothyroidism; Indeterminate pathology; Thyroid nodule