Abstract
The influence of thyroid remnant size, antithyroid antibody titre, thyroid morphology, and lymphocyte infiltration on postoperative thyroid function was studied in 179 patients undergoing subtotal thyroidectomy because of hyperthyroidism. The surgical procedure was strictly standardized and included determination of the thyroid remnant size. The preoperative medication used was beta-adrenoceptor blocking agents in 101 patients and antithyroid drugs and thyroxine in 78. With remnant size adjusted to 6–10 g (or, in goiters less than 20 g, to 25–30% of initial gland weight), the overall recurrence rate after 2–8 years (mean 5.3±2.0) of follow-up was 1.7% and the incidence of thyroid hypofunction was 29.6%.
In toxic nodular goiter (TNG; n=63), a significant negative correlation was found between TSH and remnant size after 12 months as well as a significantly lower remnant weight in patients developing postoperative hypothyroidism. In toxic diffuse goiter (TDG; n=116), there was no difference in remnant size between euthyroid and hypothyroid patients. For patients with TDG treated preoperatively with beta-blockers, the incidence of autoantibodies against thyroid cytoplasm was increased in patients who postoperatively developed thyroid dysfunction. Within the group of TDG developing hypofunction, we found increased titre of autoantibodies and “presence of lymphoid tissue” more often in patients treated preoperatively with beta-blockers compared to thyrostatics. In toxic nodular goiter, the remnant size was considered the parameter most helpful to the surgeon in predicting postoperative thyroid function.
Résumé
L'influence de la taille du parenchyme thyroÏdien restant, du taux de l'anticorps anti-thyroÏdien, de la morphologie thyroÏdienne, de l'infiltration lymphocytaire sur la fonction postopératoire de la thyroÏde a été étudiée chez 179 malades qui ont subi une thyroÏdectomie subtotale pour hyperthyroÏdie. La technique opératoire a été uniforme prenant en compte la taille du parenchyme thyroÏdien laissé en place. La préparation à l'intervention a été réalisée en employant des béta-bloquants chez 101 malades, des médicaments anti-thyroÏdiens et de la thyroxine chez 78 patients. Pour un moignon de parenchyme thyroÏdien de 6–10 g (ou lorsque le goitre pesait moins de 20 g, un moignon thyroÏdien représentant 25–30% du poids initial de la glande), le taux global de récidive après 2–8 ans (moyenne 5.3 ±2.0) a été de 1.7% et le taux d'hypothyroÏdie de 29.6%.
En cas de goitre nodulaire toxique (n=63) une corrélation négative significative a été observée après 12 mois entre le taux de TSH et la taille du moignon thyroÏdien ainsi qu'une diminution du poids du parenchyme restant chez les malades accusant un hypothyroÏdisme post-opératoire. En cas de goitre toxique diffus (n=116), il ne fut pas constaté de différence dans la taille du parencyme restant, que l'opéré fut euthyroÏdien ou hypothyroÏdien. Chez les malades porteurs d'un goitre toxique diffus préparés avant l'intervention par des béta-bloquants, le taux des auto-anticorps contre le cytoplasme thyroÏdien s'est montré plus élevé lorsque les opérés ont développé une hypothyroÏdie. Chez les malades porteurs d'un goitre toxique diffus qui ont accusé une hypofonction thyroÏdienne, il a été constaté une augmentation du taux des auto-anticorps et l'existence de tissu lymphoÏde plus souvent chez les patients qui avaient été préparés par un béta-bloquant que chez ceux préparés par un médicament thyroÏdostatique. En cas de goitre nodulaire toxique la taille du parenchyme restant a représenté le paramètre le plus utile pour prédire la fonction post-opératoire thyroÏdienne.
Resumen
La influencia del volumen del remanente tiroideo, del título de anticuerpos antitiroideos, de la morfología tiroidea, y de la presencia de infiltración linfocítica sobre la función tiroidea postoperatoria fue estudiada en 179 pacientes sometidos a tiroidectomía subtotal por hipertiroidismo. El procedimiento quirÚrgico fue estrictamente estandarizado e incluyó la determinación del tamaño del remanente tiroideo. La medicación preoperatoria utilizada fue con agentes bloqueadores de beta-adrenoceptores en 101 de los pacientes y con tiroxina en 78. Con remanentes tiroideos limitados a 6–10 g (o, en bocios de menos de 20 g, a 25–30% del peso inicial de la glándula), la tasa general de recurrencia a los 2–8 años (promedio 5.3±2.0) de seguimiento fue 1.7% y la incidencia de hipofunción tiroidea 29.6%.
En el bocio nodular tóxico (BNT; n=63), se halló una significativa correlación negativa entre TSH y el tamaño del remanente a los 12 meses, así como un remanente de peso significativamente menor en los pacientes que desarrollaron hipotiroidismo postoperatorio. En el bocio difuso tóxico (BDT; n=116), no se halló diferencia en cuanto al tamaño del remanente entre los pacientes eutiroideos y los hipotiroideos. Entre los pacientes con BDT tratados preoperatoriamente con betabloqueadores, se encontró aumento en la incidencia de autoanticuerpos contra el citoplasma tiroideo en aquellos que desarrollaron disfunción tiroidea postoperatoria. En el grupo con BDT que desarrolló hipofunción, encontramos aumento en el título de autoanticuerpos y la “presencia de tejido linfoide” con mayor frecuencia en aquellos tratados preoperatoriamente con betabloqueadores en comparación con los que recibieron tratamiento con tirostáticos. En el BNT, el remanente tiroideo fue considerado como el parámetro de mayor utilidad para el cirujano en cuanto a la predicción de la función tiroidea postoperatoria.
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Jörtsö, E., Lennquist, S., Lundström, B. et al. The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism. World J. Surg. 11, 365–370 (1987). https://doi.org/10.1007/BF01658118
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DOI: https://doi.org/10.1007/BF01658118