Minimally invasive thyroid nodulectomy reduces post-operative hypothyroidism when compared with thyroid lobectomy.
BACKGROUND
It has been a long-standing surgical tenet that the minimum surgical procedure for a single thyroid nodule is lobectomy. Such an approach, however, has been associated with a significant incidence of post-operative hypothyroidism with patients becoming medication dependent for life. Thermal sealing devices have enabled local nodule excision to be undertaken safely with preservation of more residual thyroid mass. The aim of this study was to determine if this approach was associated with a reduction in post-operative hypothyroidism.


METHODS
This is a retrospective cohort study comprising 351 patients treated between January 2010 and December 2012. Patients were assessed at 6-8-week review. Subclinical hypothyroidism was defined as a thyroid-stimulating hormone (TSH) >4.5 mIU/L, with clinical hypothyroidism defined as both an elevated TSH and presence of clinical symptoms requiring thyroxine replacement.


RESULTS
One hundred and ninety patients underwent open thyroid lobectomy, 86 a minimally invasive thyroid lobectomy and 75 a minimally invasive nodulectomy. There was no difference in post-operative hypothyroidism after lobectomy whether by the open (22.1%) or minimally invasive (22.1%) technique. However, after minimally invasive nodulectomy, post-operative hypothyroidism was less than one quarter (5.3%) of that following lobectomy overall (22.1%, P < 0.01). There were no differences in post-operative complications between any of the groups.


CONCLUSIONS
Minimally invasive local nodule excision can be performed safely, with the potential for significantly reducing the rate of post-operative hypothyroidism. As such, the procedure should be considered for appropriately selected patients.
Endocrine Surgical Unit, The University of Sydney, Sydney, New South Wales, Australia.
Leba M
LM
Sarkis
Endocrine Surgical Unit, The University of Sydney, Sydney, New South Wales, Australia.
Olov
O
Norlen
Endocrine Surgical Unit, The University of Sydney, Sydney, New South Wales, Australia.
Mark
M
Sywak
Endocrine Surgical Unit, The University of Sydney, Sydney, New South Wales, Australia.
Leigh
L
Delbridge
D000328:Adult; D000368:Aged; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000639:trends; D013972:Thyrotropin / Q000032:analysis; D013974:Thyroxine / Q000627:therapeutic use; D014463:Ultrasonography
D013972:Thyrotropin; D013974:Thyroxine
lobectomy; minimally invasive; nodulectomy; single thyroid nodule