ASPO060 - Variables Aassociated With Poor Adherence To Thyroid Hormone Replacement Therapy In Children Following Total Thyroidectomy
Saturday, April 30, 2022
5:00 PM – 5:30 PM CT
Location: Landmark B
Inbal Hazkani, MD1, Eli Stein, BS2, Evan Edwards, MME2, John Maddalozzo, MD1, Douglas Johnston, MD1, Jill Samis, MD3, Jami Josefson, MD MS3, Jeffrey Rastatter, MD MS1;
1Otolaryngology, Ann and Robert H. Lurie Children's Hosp. of Chicago, Northwestern Univ., Chicago, IL, 2Department of Otolaryngology - Head & Neck Surgery, Northwestern Univ., Chicago, IL, 3Department of Pediatrics, Ann and Robert H. Lurie Children's Hosp. of Chicago, Northwestern Univ., Chicago, IL.
Fellow Lurie Children's Hospital, Northwestern university
Introduction: Hypothyroidism in children is associated with growth and development retardation, yet adherence to thyroid hormone replacement therapy may be challenging. The characteristics that are associated with poor adherence to thyroid hormone replacement therapy among children following total thyroidectomy have not been evaluated yet.
Methods: This was a retrospective cohort study of children who underwent total thyroidectomy by a high-volume pediatric otolaryngologist surgeon between 1/2014-9/2021. Patient demographics, levels of thyroid stimulating hormone (TSH) and free T4 prior to and following thyroidectomy and outpatient follow up data were extracted. Poor adherence was characterized by at least three separate measurements of high TSH levels not associated with radioactive iodine treatment.
Results: There were 105 patients, age 3-20 year-old who met inclusion criteria; 48 patients underwent total thyroidectomy for cancer diagnosis, and 57 for Graves disease. The mean follow-up time was 36.2 months (range 1.1-95.6 months). Overall, 42 patients (40%) were found to have at least three measurements of high TSH during follow up. Clinical hypothyroidism (high TSH and low free T4) on three different occasions was diagnosed in 23 patients (21.9%). Sex, race, income, insurance type and benign vs malignant etiology for thyroidectomy were not associated with adherence to therapy. Multivariate regression analysis identified patients with Graves disease and thyrotoxicosis at time of surgery and Hispanic ethnicity to be associated with poor adherence (OR 3.83, 95% CI 1.0-15.7, p=0.05 and OR 7.14, 95% CI 0.93-2.12, p=0.034, respectively). Age at time of surgery was found to approach significance as well (p=0.07).
Conclusion: Thyrotoxicosis at time of thyroidectomy and Hispanic ethnicity are associated with poor adherence to thyroid hormone replacement therapy. Need for life-long treatment with thyroid hormones should be emphasized when counseling these patients prior to total thyroidectomy.