Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-20T11:33:54.117Z Has data issue: false hasContentIssue false
  • English
  • Français

Does thyroid-sparing total laryngectomy decrease the risk of hypothyroidism?

Published online by Cambridge University Press:  27 November 2020

G Viljoen ,
J K McGuire ,
A Alhadad ,
S Dalvie  and
J J Fagan
G Viljoen*
Affiliation:
Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
J K McGuire
Affiliation:
Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
A Alhadad
Affiliation:
Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
S Dalvie
Affiliation:
Division of Radiation Oncology, Faculty of Health Sciences, University of Cape Town, South Africa
J J Fagan
Affiliation:
Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa
*
Author for correspondence: Dr Gerrit Viljoen, Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town7700, South Africa E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network (‘NCCN’) guidelines. However, it is associated with a 32–89 per cent risk of hypothyroidism, with or without adjuvant radiotherapy.

Objective

The study aimed to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of total laryngectomy.

Method

A retrospective study was conducted at Groote Schuur Hospital in Cape Town, South Africa.

Results

Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2 per cent. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid-sparing total laryngectomy compared to hemithyroidectomy (p = 0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p = 0.001).

Conclusion

Thyroid-preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma, as it reduces the incidence of hypothyroidism.

Keywords

Laryngeal CancerHead And Neck CancerLaryngectomyThyroidectomyHypothyroidism
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 12 , December 2020 , pp. 1069 - 1072
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr G Viljoen takes responsibility for the integrity of the content of the paper

References

Brennan, JA, Meyers, AD, Jafek, BW. The intraoperative management of the thyroid gland during laryngectomy. Laryngoscope 1991;101:929–34CrossRefGoogle ScholarPubMed
Gürbüz, MK, Açikalin, M, Tasar, S, Çakli, H, Yorulmaz, G, Erdinç, M et al. Clinical effectiveness of thyroidectomy on the management of locally advanced laryngeal cancer. Auris Nasus Larynx 2014;41:69–75CrossRefGoogle ScholarPubMed
NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers 2018. In: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf [13 November 2020]Google Scholar
Kumar, R, Drinnan, M, Robinson, M, Meikle, D, Stafford, F, Welch, A et al. Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature. Clin Otolaryngol 2013;38:372–8CrossRefGoogle ScholarPubMed
Léon, X, Gras, JR, Pérez, A, Rodríguez, J, de Andrés, L, Orús, C et al. Hypothyroidism in patients treated with total laryngectomy. A multivariate study. Eur Arch Otorhinolaryngol 2002;259:193–6Google ScholarPubMed
Ho, AC, Ho, W, Lam, PK, Yuen, AP, Wei, WI. Thyroid dysfunction in laryngectomees—10 years after treatment. Head Neck 2008;30:336–40CrossRefGoogle ScholarPubMed
Palmer, B, Gaggar, N, Shaw, N. Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx. Head Neck Surg 1981;4:13–15CrossRefGoogle ScholarPubMed
Buisset, E, Leclerc, L, Lefebvre, J-L, Stern, J, Ton-Van, J, Gosselin, P et al. Hypothyroidism following combined treatment for hypopharyngeal and laryngeal carcinoma. Am J Surg 1991;162:345–7CrossRefGoogle ScholarPubMed
Agarwal, V, Branstetter, BF 4th, Johnson, JT. Indications for PET/CT in the head and neck. Otolaryngol Clin North Am 2008;41:23–49CrossRefGoogle ScholarPubMed
Mourad, M, Saman, M, Sawhney, R, Ducic, Y. Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma. Laryngoscope 2015;125:1835–8CrossRefGoogle ScholarPubMed
Fualal, J, Ehrenkranz, J. Access, availability, and infrastructure deficiency: the current management of thyroid disease in the developing world. Rev Endocr Metab Disord 2016;17:583–9CrossRefGoogle ScholarPubMed
Biel, MA, Maisel, RH. Indications for performing hemithyroidectomy for tumors requiring total laryngectomy. Am J Surg 1985;150:435–9CrossRefGoogle ScholarPubMed
McGuire, JK, Viljoen, G, Rocke, J, Fitzpatrick, S, Dalvie, S, Fagan, JJ. Does thyroid gland preserving total laryngectomy affect oncological control in laryngeal carcinoma? Laryngoscope 2020;130:1465–9CrossRefGoogle ScholarPubMed
Ogura, JH. Surgical pathology of cancer of the larynx. Laryngoscope 1955;65:867–926CrossRefGoogle Scholar
Harrison, DFN. The pathology and management of subglottic cancer. Ann Otol Rhinol Laryngol 1971;80:6–12CrossRefGoogle ScholarPubMed
Harrison, DFN. Thyroid gland in the management of laryngopharyngeal cancer. Arch Otolaryngol 1973;97:301–2CrossRefGoogle ScholarPubMed
Cannon, CR. Hypothyroidism in head and neck cancer patients: experimental and clinical observations. Laryngoscope 1994;104:1–21CrossRefGoogle ScholarPubMed
Murken, RE, Duvall, AJ. Symposium on malignancy. V. Hypothyroidism following combined therapy in carcinoma of the laryngopharynx. Laryngoscope 1972;82:1306–14CrossRefGoogle Scholar
Vanderpump, MPJ, Tunbridge, WMG. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002;12:839–47CrossRefGoogle ScholarPubMed
Vanderpump, MPJ, Tunbridge, WMG, French, JM, Appleton, D, Bates, D, Clark, F et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55–68CrossRefGoogle ScholarPubMed
Tunbridge, WMG, Evered, DC, Hall, R, Appleton, D, Brewis, M, Clark, F et al. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 1977;7:481–93CrossRefGoogle Scholar
Sawin, CT, Castelli, WP, Hershman, JM, McNamara, P, Bacharach, P. The aging thyroid: thyroid deficiency in the Framingham Study. Arch Intern Med 1985;145:1386–8CrossRefGoogle ScholarPubMed
Negm, H, Mosleh, M, Fathy, H, Awad, A. Thyroid and parathyroid dysfunction after total laryngectomy in patients with laryngeal carcinoma. Eur Arch Otorhinolaryngol 2016;273:3237–41CrossRefGoogle ScholarPubMed
Said, M, Chiu, V, Haigh, PI. Hypothyroidism after hemithyroidectomy. World J Surg 2013;37:2839–44CrossRefGoogle ScholarPubMed
Tabatabaie, V, Surks, MI. The aging thyroid. Curr Opin Endocrinol Diabetes Obes 2013;20:455–9CrossRefGoogle ScholarPubMed
Gal, RL, Gal, TJ, Klotch, DW, Cantor, AB. Risk factors associated with hypothyroidism after laryngectomy. Otolaryngol Neck Surg 2000;123:211–17CrossRefGoogle ScholarPubMed
Posner, MR, Ervin, TJ, Fabian, RL, Weichselbaum, RR, Miller, D, Norris, CM Jr et al. Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck. Laryngoscope 1984;94:451–4CrossRefGoogle ScholarPubMed
Vrabec, DP, Heffron, TJ. Hypothyroidism following treatment for head and neck cancer. Ann Otol Rhinol Laryngol 1981;90:449–53CrossRefGoogle ScholarPubMed
León, X, Quer, M, Burgués, J, Abelló, P, Vega, M, de Andrés, L. Prevention of stomal recurrence. Head Neck 1996;18:54–93.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Tell, R, Lundell, G, Nilsson, B, Sjödin, H, Lewin, F, Lewensohn, R. Long-term incidence of hypothyroidism after radiotherapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004;60:395–400CrossRefGoogle ScholarPubMed
Verloop, H, Smit, JWA, Louwerens, M, Dekkers, OM, Kievit, J, Schoones, JW. Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies. J Clin Endocrinol Metab 2012;97:2243–55CrossRefGoogle ScholarPubMed
Hancock, SL, Cox, RS, McDougall, IR. Thyroid diseases after treatment of Hodgkin's disease. N Engl J Med 1991;325:599–605CrossRefGoogle ScholarPubMed
Diaz, R, Jaboin, JJ, Morales-Paliza, M, Koehler, E, Phillips, JG, Stinson, S et al. Hypothyroidism as a consequence of intensity-modulated radiotherapy with concurrent taxane-based chemotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;77:468–76CrossRefGoogle ScholarPubMed
Alterio, D, Jereczek-Fossa, BA, Franchi, B, D'Onofrio, A, Piazzi, V, Rondi, E et al. Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients. Int J Radiat Oncol Biol Phys 2007;67:144–50CrossRefGoogle ScholarPubMed
Bhandare, N, Kennedy, L, Malyapa, RS, Morris, CG, Mendenhall, WM. Primary and central hypothyroidism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys 2007;68:1131–9CrossRefGoogle ScholarPubMed
Kuten, A, Lubochitski, R, Fishman, G, Dale, J, Stein, ME. Postradiotherapy hypothyroidism: radiation dose response and chemotherapeutic radiosensitization at less than 40 Gy. J Surg Oncol 1996;61:281–33.0.CO;2-9>CrossRefGoogle ScholarPubMed
Norris, AA, Amdur, RJ, Morris, CG, Mendenhall, WM. Hypothyroidism when the thyroid is included only in the low neck field during head and neck radiotherapy. Am J Clin Oncol 2006;29:442–5CrossRefGoogle ScholarPubMed
Boomsma, MJ, Bijl, HP, Langendijk, JA. Radiation-induced hypothyroidism in head and neck cancer patients: a systematic review. Radiother Oncol 2011;99:1–5CrossRefGoogle ScholarPubMed
Rubin, P, Casarett, GW. The endocrine glands. Clin Radiat Pathol 1968;2:721–67Google Scholar
Kojima, R, Tsukahara, K, Motohashi, R, Okada, T. Extent of thyroid resection and thyroid function after postoperative radiotherapy following total laryngectomy or total pharyngo-laryngo-esophagectomy. Int J Clin Oncol 2017;22:438–41CrossRefGoogle ScholarPubMed
Grande, C. Hypothyroidism following radiotherapy for head and neck cancer: multivariate analysis of risk factors. Radiother Oncol 1992;25:31–6CrossRefGoogle ScholarPubMed