Hipotiroidismo posthemitiroidectomía. Prevalencia y marcadores predictivos. Comparación entre pacientes con bocio nodular eutiroideo e hipertiroideo

Abstract

Background and objective

Posthemithyroidectomy hypothyroidism (PHH) is a relatively common complication (22-30%) for which we have no published information from our country. The objective of the study is to determine the prevalence of PHH and evaluate its predictive markers by comparing patients who had euthyroidism with those who had hyperthyroidism before hemithyroidectomy.

Patients and method

Retrospective observational cross-sectional study on 106 patients, 88 euthyroid before hemithyroidectomy and 18 hyperthyroid.

Results

Prevalence of PHH in euthyroid patients 42% (89.2% subclinical hypothyroidism; 10.8% manifest hypothyroidism) and in hyperthyroid patients 50% (77.8% subclinical hypothyroidism; 22.2% manifest hypothyroidism). Predictive markers in euthyroid patients: preoperative thyrotropin ≥ 2.2 mIU/L (OR: 4.278, 95% CI: 1.689-10.833; sensitivity: 54.1%, 95% CI: 38-70.1%; specificity:78.4%, 95% CI:67.1-89.7%), age ≥ 50 years (OR: 3.509, 95% CI: 1.438-8.563; sensitivity: 64.9%, 95% CI: 49.5-80.3%; specificity: 64.7%, 95% CI: 51.6-77.8%) and percentage of remainder lobe ≤ 19.6% (OR: 1.024, 95% CI: 1.002-1.046; sensitivity: 70.2%, 95% CI: 55.5-84.9%; specificity: 48.6%, 95% CI: 34.9-62.3%). Predictive marker in hyperthyroid patients: weight > 70 kg (OR: 28, 95% CI: 2.067-379.247; sensitivity: 88.9%, 95% CI: 68.4-100%; specificity: 88.9%, 95% CI:68.4-100%).

Conclusions

This is the first study in our country that demonstrates a prevalence of PHH above the average in euthyroid patients, which is slightly higher and more intense in hyperthyroid patients, and that recognizes the classic predictive markers in euthyroid patients but highlights a novel predictive marker marker in hyperthyroid patients, useful to assess a different risk of PHH when indicating hemithyroidectomy and to establish closer control of postoperative hormonal evolution.