THYROID AUTO-IMMUNITY AS A RISK FACTOR FOR RECURRENT MULTINODULAR GOITER AFTER HEMITHYROIDECTOMY

Authors

  • Filipe Borges Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal; Faculdade de Medicina da Universidade de Lisboa – Portugal http://orcid.org/0000-0001-5529-2045
  • Ricardo Marques Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal
  • Isabel Nascimento Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal http://orcid.org/0000-0003-0780-6210
  • Luísa Raimundo Serviço de Endocrinologia, Hospital de Garcia de Orta, Almada – Portugal
  • Jorge Portugal Serviço de Endocrinologia, Hospital de Garcia de Orta, Almada – Portugal
  • Paulo Matos Costa Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal; Faculdade de Medicina da Universidade de Lisboa – Portugal http://orcid.org/0000-0002-7550-8285

DOI:

https://doi.org/10.34635/rpc.862

Keywords:

multinodular goiter, hemithyroidectomy, auto-immunity, risk factor

Abstract

Background. The ideal surgical strategy to multinodular goiter (MNG) is currently still matter of discussion. Thyroid auto- immunity is a well-known risk factor for hypothyroidism and could play a role in MNG’s physiopathology. Objective. Assess thyroid auto-immunity as a risk factor for MNG recurrence.

Materials and Methods. Retrospective analysis of a 5-year (January 2012 – December 2016) prospective database of all patients submitted to hemythyroidectomy for MNG. Variables: age, gender, preoperative diagnosis, anti-peroxidase and anti-thyroglobulin antibodies (anti-TPO and anti-Tg); postoperative L-thyroxin therapy, MNG recurrence, contralateral thyroidectomy. MNG recurrence was defined as the need for complementary contralateral lobectomy, or the appearance of new nodules, or an increase in size of at least 50% of the nodules in the remnant lobe.

Results. 82 patients included. Median follow-up time of 49 months [33 –88]. Thyroid auto-immunity (anti-TPO and/or anti-Tg) was present in 26% of the patients. 39% of the patients required replacement postoperative L-thyroxin therapy. Recurrence of MNG was observed in 15,2% of the patients but none required contralateral thyroidectomy. Univariate analysis did not show a statistical significant relationship between thyroid autoimmunity and MNG recurrence (p – 0, 461).

Discussion / Conclusion. Thyroid autoimmunity dos not seem to represent a risk factor for MNG recurrence after hemythyroidectomy. This surgical approach was effective, with a low recurrence rate. Also the clinical impact of such recurrence was low with no patient needing contralateral resection.

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References

1. Philip S. Bauer, MS, Sara Murray, MD, Nicholas Clark, BS, et al. “Unilateral thyroidectomy for the treatment of benign multinodular goiter.” J Surg Res. 184 (1) (September 2013): 514–518.

2. W. Attaallah1, S. Erel2, N.Z. Canturk3, Y. et al. “Is hemithyroidectomy a rational management for benign nodular goitre? A Multicentre Retrospective Single Group Study.” The Netherlands Journal of Medicine 73 (1) (January 2015): 17 - 22.

3. Eleonore Fröhlich, Richard Wahl. “Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroi and Extra-Thyroidal Diseases.” Frontiers in Immunology 8: 521 (May 2017).

4. Miccoli, P., G. Frustaci, e A. Fosso et al. “Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation.” February 2014.

5. Rocco Bellantone, MD, Celestino Pio Lombardi, MD, Mauro Boscherini. “Predictive factors for recurrence after thyroid lobectomy for unilateral non- toxic goiter in an endemic area: Results of a multivariate analysis.” Surgery, 2004.

6. Cirocchi R, Trastulli S, Randolph J et al. “Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults (Review).” Cochrane Library 8 (2015).

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Published

2022-12-09

Issue

No. 53 (2022): December 2022

Section

Original Papers

License

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