J Korean Surg Soc.  2011 Dec;81(6):380-386. 10.4174/jkss.2011.81.6.380.

Is it possible to predict hypothyroidism after thyroid lobectomy through thyrotropin, thyroglobulin, anti-thyroglobulin, and anti-microsomal antibody?

• Cho JS
• Shin SH
• Song YJ
• Kim HK
• Park MH
• Yoon JH
• Jegal YJ

• KMID: 1445766
• DOI: http://doi.org/10.4174/jkss.2011.81.6.380

Abstract

PURPOSE
We investigated the incidence and risk factors of hypothyroidism after thyroid lobectomy, and evaluated the possibility to predict hypothyroidism preoperatively with serologic markers, such as thyrotropin (TSH), thyroglobulin (TG), anti-thyroglobulin (ATA), and anti-microsomal antibody (AMA).
METHODS
We enrolled 123 consecutive patients who underwent thyroid lobectomy due to benign conditions between May 2004 and April 2008. Only preoperative euthyroid patients were included. Patients were divided into two groups by postoperative thyroid function outcomes, into hypothyroid (n = 97) and euthyroid groups (n = 26), and analyzed specially for the preoperative levels of TSH, TG, ATA, and AMA.
RESULTS
Twenty-six (21.1%) patients developed hypothyroidism following thyroid lobectomy within 35.7 months of follow-up. The proportion of post-lobectomy hypothyroidism was high in patients with high-normal preoperative TSH level, and the cut-off value was 2.0 mIU/L, with 67% sensitivity and 75% specificity. The quantitative titer of preoperative TG, ATA, and AMA was not significant, but the outcome of categorical analysis of two or more positivities on these three markers was significantly higher in hypothyroid patients than in euthyroid patients (28.6% vs. 3.9%, P = 0.024). The combined positivity of preoperative TSH and two or more positivities of TG, ATA, and AMA possess 100% positive predictive value and 81% negative predictive value.
CONCLUSION
The incidence of hypothyroidism following thyroid lobectomy was 21.1%. High-normal preoperative TSH and two or more positivities for TG, ATA, and AMA are good pre-operative predictive markers. Such high-risk patients need close TSH monitoring before the onset of clinical hypothyroidism.

Keyword

Hypothyroidism; Thyrotropin; Thyroglobulin; Thyroid microsomal antibodies

MeSH Terms

Autoantibodies
Follow-Up Studies
Humans
Hypothyroidism
Incidence
Risk Factors
Sensitivity and Specificity
Thyroglobulin
Thyroid Gland
Thyrotropin
Autoantibodies
Thyroglobulin
Thyrotropin

Figure

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  Fig. 1 Time course of hypothyroidism after thyroid lobectomy. Routine thyroid function test monitoring was performed at 3, 6, 12, 18th month after surgery. About 10%, 5% and 14% of patients experienced overt clinical hypothyroidism at 3, 9 and 18 months respectively.

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