Risk Factors Associated with Hypothyroidism after Laryngectomy

Abstract

Hypothyroidism is a well-documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy. The Cox proportional hazards model was used to identify factors significantly related to an increased risk for development of hypothyroidism. The actuarial method was used to estimate the period of greatest risk for the development of hypothyroidism. Increased risks were found for patients who were female (P = 0.0049), received preoperative radiation therapy (P = 0.0022), had invasion of the thyroid gland by tumor (P = 0.0003), had presence of cervical metastases (P = 0.0022), and had postoperative fistula (P = 0.0095). From the actuarial method, we estimated that the period of time when patients were at greatest risk for development of hypothyroidism was between 0 and 14 months after surgical intervention. Wound complications were twice as frequent in hypothyroid patients. Perioperative awareness of risk factors associated with the development of hypothyroidism in patients undergoing laryngectomy allows for early recognition and management of hypothyroidism and may reduce the number of complications related to wound healing and fistula.

Hypothyroidism in patients treated with total laryngectomy. A multivariate study

“…In some studies with head and neck carcinoma patients, hypothyroidism appeared more frequently in women [4,8,16], possibly in relation to the increased prevalence of thyroid disorders in females. Other authors did not find any relation between sex and hypothyroidism in head and neck cancer patients [5,13].…”

“…The use of chemotherapy has not been related to hypothyroidism in different studies [5,8,10,14]. In a multivariate study by Gal et al [4] in a group of 136 patients treated with a total laryngectomy, the risk factors related with the appearance of hypothyroidism were invasion of the thyroid gland by a tumour, pre-operative radiation therapy, presence of neck node metastases and female sex.…”

“…The combined treatment of surgery and radiotherapy [4,5,8,10,12,16], the inclusion of all the thyroid gland in the field of radiotherapy treatment [5,13], the radiotherapy doses [17] and the performance of hemithyroidectomy [2,3,4,5,10,12,14,16,17] have been variables related to the appearance of hypothyroidism in head and neck cancer patients.…”

Hipotiroidismo Secundário à Irradiação Cervical: Avaliação Sistemática da Função Tiroideia no Seguimento

“…1,9,26,30,31 Nomeadamente, Bhandare et al, encontraram uma diferença significativa na incidência de hipotiroidismo, quando compararam os doentes que receberam uma dose média na glândula tiroideia superior ou igual a 45 Gy com aqueles que receberam uma dose média inferior a este valor. 8 No primeiro grupo verificou-se uma incidência significativamente superior de hipotiroidismo (27% aos cinco anos e 39% aos dez anos), comparativamente aos doentes que receberam uma dose média inferior a 45 Gy (21% aos cinco e aos dez anos).…”

Larenks kanserli hastalarda cerrahi ve radyoterapi sonrası tiroid fonksiyonlarının prospektif olarak değerlendirilmesi

“…Bafl boyun kanserli hastalarda yap›lan baz› çal›fl-malarda HT insidans›n›n kad›nlarda daha fazla gö-rüldü¤ü bildirilmifltir, 1,6,11 ancak bizim hastalar›m›z›n tamam›n›n erkek olmas› nedeniyle bu de¤iflkeni de¤erlendirme imkân›m›z olmad›. …”