Thyroid-Stimulating Hormone Testing and Outcomes in Total Laryngectomy Patients.

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

Annals of Otology Rhinology and Laryngology Pub Date : 2025-02-16 DOI:10.1177/00034894251320883

James D Warren, Kacie R Oglesby, Carlton R Homan, Edmund Howe, Oishika Paul, Patrick Tassone, Anne C Kane

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引用次数: 0

Abstract

Objective: Assess timing and prevalence of thyroid-stimulating hormone (TSH) testing after total laryngectomy (TL). Identify prevalence of postoperative hypothyroidism and determine associations between thyroidectomy, postoperative hypothyroidism, and wound complications, including pharyngocutaneous fistula (PCF).

Methods: Retrospective chart review performed at 2 tertiary care centers of adult patients undergoing TL between 2013 and 2021. Demographic data, perioperative labs and post-operative outcomes were collected. Analysis was performed.

Results: Of 237 patients identified, thyroid removal was performed in 156 (65.8%), including 23 (9.7%) total thyroidectomies and 133 (56.1%) hemi-thyroidectomies. Of the 191 (80.6%) receiving postoperative TSH testing, 98 (41.4%) had TSH testing within 90 days, and 112 (58.6%) developed hypothyroidism. Mean postoperative TSH testing interval was 222.0 days (SSD 400.2), with variations associated with age (P = .026), gender (P = .009), PCF formation (P < .001), history of radiation therapy (RT, P = .011), and preoperative levothyroxine use (P = .031). Partial or total thyroid removal significantly increased the likelihood of high postoperative TSH (OR = 2.631, P = .002, 95% CI [1.410, 4.911]). PCF occurred in 62 (26.2%) patients, and there were no significant associations between pre/postoperative TSH or thyroid removal and PCF development or wound complications.

Conclusion: Thyroidectomy was associated with elevated postoperative TSH levels, adding support to prior literature for consideration of avoiding thyroid removal during TL when appropriate. The wide range of TSH testing intervals and prevalence of postoperative hypothyroidism in our cohort highlights the importance of monitoring thyroid function in TL patients during the perioperative period.

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目的评估全喉切除术（TL）后促甲状腺激素（TSH）检测的时间和流行率。确定术后甲状腺功能减退症的发病率，并确定甲状腺切除术、术后甲状腺功能减退症和伤口并发症（包括咽瘘 (PCF)）之间的关联：在两家三级医疗中心对2013年至2021年间接受TL手术的成年患者进行回顾性病历审查。收集了人口统计学数据、围手术期实验室检查和术后结果。结果在确定的 237 例患者中，156 例（65.8%）进行了甲状腺切除术，包括 23 例（9.7%）全甲状腺切除术和 133 例（56.1%）半甲状腺切除术。在接受术后 TSH 检测的 191 例（80.6%）患者中，98 例（41.4%）在 90 天内接受了 TSH 检测，112 例（58.6%）出现了甲状腺功能减退。术后 TSH 检测的平均间隔时间为 222.0 天（SSD 400.2），其变化与年龄（P = .026）、性别（P = .009）、PCF 的形成（P P = .011）和术前左甲状腺素的使用（P = .031）有关。甲状腺部分或全部切除会显著增加术后 TSH 偏高的可能性（OR = 2.631，P = .002，95% CI [1.410，4.911]）。62例（26.2%）患者发生了PCF，术前/术后TSH或甲状腺切除与PCF的发生或伤口并发症之间无明显关联：结论：甲状腺切除术与术后促甲状腺激素水平升高有关，这为之前的文献提供了支持，即考虑在TL期间酌情避免切除甲状腺。在我们的队列中，TSH检测时间间隔范围很广，术后甲状腺功能减退症的发生率也很高，这凸显了在围手术期监测TL患者甲状腺功能的重要性。

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来源期刊

Annals of Otology Rhinology and Laryngology 医学-耳鼻喉科学

CiteScore

3.10

自引率

7.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.