Thyroid hormone replacement following lobectomy: Long-term institutional analysis 15 years after surgery

Background: The decision to pursue lobectomy versus total thyroidectomy is highly individualized. The rate of thyroid hormone replacement therapy after lobectomy varies considerably (15%-48%) and studies are limited by short-term follow-up. We sought to assess long-term thyroid hormone replacement therapy-requirement for lobectomy. Methods: Patients undergoing lobectomy from January 2005 to July 2010 at an academic institution were reviewed. Demographic, laboratory, pathology, and thyroid hormone replacement therapy use were compared. Results: In total, 235 patients were included. The rate of thyroid hormone replacement therapy after lobectomy was 46.8% (110/235). The majority were female (84.7%), with a mean age of 52 +/- 1 years, 97% with benign pathology, and the median duration of follow-up was 7.2 years. Among the 110 thyroid hormone replacement therapy, the mean postoperative thyroid stimulating hormone level 9.08 +/- 0.96m IU/L and the time to thyroid hormone replacement therapy-initiation was 621 days; 24% started therapy >= 2 years after surgery. There was no difference in age, sex, or malignancy. Hashimoto thyroiditis was diagnosed in 21.8% patients who underwent thyroid hormone replacement therapy versus 8.0% of those without thyroid hormone replacement therapy (odds ratio 3.2; 95% confidence interval, 1.43-6.79; P < .001). On multivariate analysis, only Hashimoto thyroiditis was independently associated with thyroid hormone replacement therapy use (odds ratio 2.88; 95% confidence interval, 1.3-6.6; P =.012). Conclusion: With long-term follow-up, nearly 50% of patients who underwent lobectomy for benign disease required thyroid hormone replacement therapy and nearly one-quarter of these patients not starting until >= 2 years after surgery. Therefore, patients who undergo thyroid lobectomy should be counseled appropriately and thyroid function followed for a minimum of 2 years. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

Nearly 50% of patients undergoing lobectomy for benign disease required thyroid hormone replacement therapy, and one-quarter of these patients started therapy >= 2 years after surgery. Hashimoto thyroiditis was independently associated with thyroid hormone replacement therapy. Appropriate counseling and at least 2 years of follow-up of thyroid function are recommended for patients who undergo thyroid lobectomy.