Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P57

Oral Presentations

Prediction of Thyroid Hormone
Replacement Following Thyroid Lobectomy:
A Long-term Retrospective Study
Charles D. Meyer, MD (Presenter); Danielle Anderson, MD;
Marilissa Elrod, MD, PhD; Jeanelle Braxton;
Marco A. Ayala, MD
Objectives: Following thyroid lobectomy, patients are at
increased risk of postoperative hypothyroidism. We sought to
identify factors that were predictive of the need for future thyroid hormone replacement to aid in better counseling patients.
Methods: Retrospective cohort study of 478 patients from
18 to 75 years old, treated in a single academic institution,
who underwent thyroid lobectomy from January 2007 to
September 2017. Demographic data, body mass index (BMI),
indication for surgery, size of removed and remnant lobe, preoperative thyroid-stimulating hormone (TSH), final thyroid
pathology, and presence of thyroiditis were collected and analyzed using chi-square analyses, t tests, and multivariable
logistic regression to determine significant predictors.
Results: Of the 478 patients reviewed, 369 patients were
included in the analysis, of whom 30% eventually required
thyroid hormone replacement. The final pathology was benign
in 89% and malignant in 11%, with coexistent thyroiditis in
19% on histology. Increased age at time of surgery and preoperative TSH levels were predictors of need for thyroid hormone replacement. There was a 3.37 times increase in odds
(95% CI, 1.72-6.58) of requiring thyroid hormone replacement if pathology indicated malignancy relative to whether
the pathology was benign (chi-square P value <.001). On adding age at the time of surgery and preoperative TSH level to
the model, the adjusted odds ratio remained significant (P <
.001) at 4.45 (95% CI, 3.46-15.68). Sex, BMI, volume of
resected and remaining lobes, and weight of resected lobe
were not predictors of need for medication.
Conclusions: Our data suggest that age at the time of surgery,
preoperative TSH, and final pathology are strong predictors of
the need for future thyroid hormone supplementation.
Preoperative Multimodality Imaging Improves
Adenoma Localization and Operative Time in
Primary Hyperparathyroidism
James Heyman (Presenter); Courtenay Henrys; Matthew
Ward; Darryl Meeking; Ali Al-Bahrani; Constantinos Yiangou;
Volkert Wreesmann, MD, PhD
Objectives: Preoperative adenoma localization in primary
hyperparathyroidism (PHPT) may help to minimize intraoperative risk and improve surgical outcomes. However, the
optimal localization approach remains a subject of debate.
Methods: All PHPT patients who underwent central neck
exploration at our institution between 2010 and 2018

were retrospectively reviewed. We compared the accuracy of
combined sestamibi single photon emission computed tomography (SPECT) and ultrasound (US) imaging with the individual accuracy of these imaging modalities. Secondary
outcome parameters included sensitivity and specificity. We
then assessed the effect of imaging results on operative time.
Results: A total of 232 patients met inclusion criteria. US
accuracy was 59.9% for anatomic side (left/right) and 53.9%
for subsite (upper/middle/lower neck). Sestamibi accuracy
was 69.8% for anatomic side and 60.3% for subsite. The
accuracy of combined imaging was 85.3% for anatomic side
and 78.0% for subsite. Combined testing was also superior
for secondary outcome parameters. The mean operative time
for procedures with concordant imaging results across both
modalities was 23 minutes shorter than if imaging was discrepant (P = .020).
Conclusions: Combined Sestamibi SPECT and US imaging
in preoperative adenoma localization is superior to the use of
single-modality imaging. Operative time is significantly
shorter when agreement between modalities is established.
We advocate the use of combined imaging modality localization before surgery in PHPT patients.
Safety of Sutureless Thyroidectomy With
the Application of LigaSure Small Jaw in
1000 Thyroidectomies
Cheng Hsin Liu, MD (Presenter); Che-Wei Wu
Objectives: LigaSure Small Jaw (LSJ) has been popularly
used in thyroid surgery because of the advantages of decreased
intraoperative blood loss and operation time, but the safety of
its use was not well determined. This study investigated and
compared the incidences of postoperative major complications between the patients receiving sutureless thyroidectomy
with LSJ and conventional clamp-and-tie technique.
Methods: Consecutively, 1000 patients undergoing thyroidectomy during 2012 to 2019 were enrolled in this study. The
patients were divided into 2 groups: group L (500 patients)
received sutureless thyroidectomy performed with LSJ, and
group C (500 patients) received surgery performed with conventional clamp-and-tie technique. Complication rates of
postoperative hematoma, recurrent laryngeal nerve (RLN)
palsy, and hypocalcemia were compared between groups.
Results: λ Comparison of postoperative hematoma between
group C and group L (1.8% to 0%, P = .0026), risk ratio
(RR) = 19 (95% CI, 1.1088-325.5888). λ Comparison of postoperative RLN palsy between group C and group L (2.08% to
1.38%, P = .4819). λ Comparison of postoperative hypocalcemia between groups in the patients receiving total thyroidectomy (30% to 20.5%, P = .0066), RR = 1.46 (95% CI,
1.1317-1.8815).
Conclusions: LSJ provides the feasibility of completely
sutureless thyroidectomy and obtained better outcomes
regarding the complications of postoperative hematoma and
hypocalcemia compared with clamp-and-tie hemostatic technique. However, surgeons must carefully consider the

Endocrine

Conclusions: The NIS showed an SV-CO ASSN, suggestive
that COs may be associated with higher SV. The SID showed
no significant ASSN.

P57

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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