title: Pre-operative ultrasound identification of thyroiditis helps predict the need for thyroid hormone replacement after thyroid lobectomy.
abstract: OBJECTIVE
  To evaluate whether pre-operative thyroiditis identified by ultrasound (US) could help predict the need for thyroid hormone replacement (THR) following thyroid lobectomy.
  
  
  METHODS
  Data from patients who underwent thyroid lobectomy in 2006-2011, were not taking THR pre-operatively, and had ≥1 month of follow-up were reviewed retrospectively. THR was prescribed for relatively elevated thyroid-stimulating hormone (TSH) and hypothyroid symptoms. The Kaplan-Meier method was used to estimate the percentage of patients who required THR at 6, 12, 18, and 24 months postoperatively, and Cox proportional hazards regression models were used to evaluate prognostic factors for requiring post-thyroid lobectomy THR.
  
  
  RESULTS
  During follow-up, 45 of 98 patients required THR. Median follow-up among patients not requiring THR was 11.6 months (range, 1.2 to 51.3 months). Six months after thyroid lobectomy, 22% of patients were taking THR (95% confidence interval [CI], 15-32%); the proportion increased to 46% at 12 months (95% CI, 36-57%) and 55% at 18 months (95% CI, 43-67%). On univariate analysis, significant prognostic factors for postoperative THR included a pre-operative TSH level >2.5 μ international units [IU]/mL (hazard ratio [HR], 2.8; 95% CI, 1.4-5.5; P = .004) and pathology-identified thyroiditis (HR, 2.4; 95% CI, 1.3-4.3; P = .005). Patients with both pre-operative TSH >2.5 μIU/mL and US-identified thyroiditis had a 5.8-fold increased risk of requiring postoperative THR (95% CI, 2.4-13.9; P<.0001).
  
  
  CONCLUSIONS
  A pre-operative TSH level >2.5 μIU/mL significantly increases the risk of requiring THR after thyroid lobectomy. Thyroiditis can add to that prediction and guide pre-operative patient counseling and surgical decision making. US-identified thyroiditis should be reported and post-thyroid lobectomy patients followed long-term (≥18 months).
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center.
authors.forename: Lilah F
authors.initials: LF
authors.lastname: Morris
authors.forename: Isabella M
authors.initials: IM
authors.lastname: Iupe
authors.forename: Beth S
authors.initials: BS
authors.lastname: Edeiken-Monroe
authors.forename: Carla L
authors.initials: CL
authors.lastname: Warneke
authors.forename: Mandy O
authors.initials: MO
authors.lastname: Hansen
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000704:Analysis of Variance; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013963:Thyroid Hormones / Q000627:therapeutic use*; D013965:Thyroidectomy; D013966:Thyroiditis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D013972:Thyrotropin / Q000097:blood; D014463:Ultrasonography
chemical_list: D013963:Thyroid Hormones; D013972:Thyrotropin