Optimal Serum Thyroid-Stimulating Hormone Level for Patients With Papillary Thyroid Carcinoma After Lobectomy

2021 ◽  
Author(s):  
Siyuan Xu ◽  
Ying Huang ◽  
Hui Huang ◽  
Xiaohang Zhang ◽  
Jiaxin Qian ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Hormone Level ◽  
Thyroid Stimulating Hormone ◽  
Papillary Thyroid ◽  
Stimulating Hormone

scholarly journals Treatment with Intramuscular Levothyroxine in Refractory Hypothyroidism

2019 ◽  
Vol 8 (6) ◽  
pp. 319-323 ◽  
Author(s):  
María de los Ángeles Garayalde Gamboa ◽  
Melina Saban ◽  
Marina Ines Curriá
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Hormone Level ◽  
Partial Gastrectomy ◽  
Thyroid Stimulating Hormone ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Case Presentation ◽  
Iodine 131 ◽  
Multiple Episodes

Introduction: Orally and daily levothyroxine (LT4) is the treatment of choice for hypothyroidism. In the majority of cases, the lack of effectiveness by this way may be due to poor adherence; however, gastrointestinal malabsorption may explain more cases of thyroxine refractoriness than previously reputed, due to the number of occult forms of these disorders. Case Presentation: A 55-year-old white man with a diagnosis of low risk of recurrence of follicular variant of papillary thyroid carcinoma was treated with total thyroidectomy, 30 mCi iodine 131, and oral LT4. A year before he presented a gastric adenocarcinoma that required a partial gastrectomy. He evolved with multiple episodes of intestinal subocclusion that had to be treated with enterectomy in the first instance, then digestive rest and total parenteral nutrition. In spite of having made increases in oral LT4 dose (3 µg/kg), the patient persisted with a thyroid-stimulating hormone level >100 mIU/L. For this reason, we decided to administer intramuscular LT4. Conclusion: Since there are no guidelines or consensus of intramuscular LT4 use, our experience and how we decided the dose and way of administration are presented in this article to contribute to future cases.

scholarly journals Thyroid Stimulating Hormone Suppression and Recurrence After Thyroid Lobectomy For Papillary Thyroid Carcinoma

2021 ◽  
Author(s):  
Mi Rye Bae ◽  
Sung Hoon Nam ◽  
Jong-Lyel Roh ◽  
Seung-Ho Choi ◽  
Soon Yuhl Nam ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Stimulating Hormone ◽  
American Thyroid Association ◽  
Regression Analyses ◽  
Papillary Thyroid ◽  
Tsh Suppression ◽  
Thyroid Lobectomy ◽  
Stimulating Hormone

Abstract Background Thyroid lobectomy is recommended as the primary treatment for low-risk thyroid cancer. However, recurrence and hypothyroidism may develop after lobectomy, necessitating thyroid hormone supplementation. The 2015 American Thyroid Association (ATA) guidelines recommended post-lobectomy thyroid-stimulating hormone (TSH) suppression. This study examined the need for TSH suppression and recurrence after lobectomy for unilateral papillary thyroid carcinoma (PTC). Methods This study involved 369 patients who underwent thyroid lobectomy and ipsilateral central neck dissection for PTC between 2007 and 2015. Thyroid function tests were performed before and regularly after lobectomy. Binary logistic regression analyses were used to find factors predictive of the post-lobectomy need for TSH suppression that was defined by the 2015 ATA guidelines. Results Serum TSH concentrations gradually increased after lobectomy: proportions with TSH > 2 mIU/L at post-lobectomy 1, 3 ~ 6, 12, and 24 months were found in 77.0%, 82.3%, 66.7%, and 59.9%, respectively. After lobectomy, 168 (45.5%) patients received levothyroxine (T4) supplementation. Multivariate logistic regression analyses showed that pre-TSH level > 2 mIU/L was the sole independent variable predictive of the need for post-lobectomy TSH suppression (P = 0.003). During the median follow-up of 72 months, recurrence was found in 4 (1.1%) patients who never received T4 supplementation and had post-lobectomy TSH levels > 2 mIU/L. Conclusions Our data show that thyroid lobectomy for unilateral PTC is associated with a low recurrence rate, but a significant risk of hypothyroidism. Preoperative TSH level can predict the need for post-lobectomy TSH suppression compliant with the 2015 ATA guidelines.

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