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Head and Neck Surgery

(497) Thyroid Stimulating Hormone Testing and Outcomes in Total Laryngectomy Patients

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • James D. Warren, BS

    Medical Student
    University of Mississippi Medical Center
    Jackson, Mississippi, United States

    • Co-Author(s)

  • KO

    Kacie R. Oglesby, MD

    Resident
    University of Mississippi Medical Center
    JACKSON, MS, USA

  • CH

    Carlton R. Homan, BS

    Medical Student
    University of Missouri
    Springfield, MO, USA

  • EH

    Edmund Howe, BS

    Medical Student
    University of Missouri, USA

  • PT

    Patrick T. Tassone, MD

    Patrick Tassone, MD
    Department of Otolaryngology Head and Neck Surgery, University of Missouri
    Columbia, Missouri, United States

    • Senior Author(s)

  • AK

    Anne C. Kane, MD

    Assistant Professor
    University of Mississippi Medical Center
    Madison, MS, United States

Disclosure(s):
James D. Warren, BS: No relevant relationships to disclose.
Patrick T. Tassone, MD: No relevant relationships to disclose.
Anne C. Kane, MD: No relevant relationships to disclose.


Introduction: Assess prevalence of Thyroid Stimulating Hormone (TSH) testing after Total Laryngectomy (TL), relationship between thyroidectomy and post-operative TSH levels and complications related to wound healing in patients with elevated TSH.

Methods: Retrospective chart review performed at two tertiary care centers of adult patients undergoing TL between 2013-2021. Demographic data, perioperative labs and post-operative outcomes were collected. Univariate and multivariate analysis (MVA) performed.

Results: 256 patients identified; thyroid removal was performed in 158 (61.7%). 24 (9.4%) had total thyroidectomy and 134 (52.3%) hemi-thyroidectomy. 74 patients (28.9%) had pre-operative TSH testing (mean value of 5.3495). 96 patients (42.3%) had post-operative TSH testing within 90 days of surgery (mean value of 13.530). Mean interval between surgery and TSH testing was 214.29 days. Partial or total thyroid removal significantly increased the likelihood of high post-operative TSH (OR= 2.557, p=.002, 95% CI [1.419, 4.609]). Pharyngocutaneous fistula (PCF) occurred in 66 patients (25.8%). MVA performed on pre-operative variables showed history of radiation increased likelihood of PCF (OR=24.898, p=0.02, 95% [CI 1.662, 373.067]). High post-operative TSH increased the likelihood of PCF on MVA (OR=4.587, p=0.016, 95% CI [1.326, 15.860]) when compared to history of radiation, chemotherapy and low prealbumin. PTH was more likely to be low in patients with elevated post-operative TSH (57.9% vs 26.7%, p=0.069). Area Disparity Index (ADI) was available for 251 patients. There was no significant difference between ADI quintiles regarding interval from surgery to TSH testing, rates of PCF or wound complications.

Conclusions: Thyroidectomy was associated with elevated post-operative TSH levels adding support to prior literature for consideration of avoiding thyroid removal during TL when possible. Association between high post-operative TSH and PCF formation, combined with a wide range of TSH testing intervals, suggests the need for standardized pre- and post-operative TSH testing protocols in TL patients.