DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20221880
Published: 2022-07-26

Role of hemithyroid preservation in total laryngectomy for laryngeal/hypopharyngeal malignancy

Architha Menon Premachandran, Balakrishnan Ramaswamy, K. Devaraja, Kailesh Pujary, Dipak Ranjan Nayak

Abstract


Background: Thyroid gland invasion in advanced laryngeal/hypopharyngeal malignancy is not uncommon. The preservation of the contralateral lobe of thyroid and associated parathyroid glands with its blood supply, in suitable patients, can be beneficial in reducing the incidence of both hypothyroidism and hypoparathyroidism. The aim of the study was to assess the functionality of the contralateral preserved hemi-thyroid gland with its parathyroid glands, during total laryngectomy with or without partial/total pharyngectomy (TL/TLP), with or without post-operative radiation therapy.

Methods: A retrospective study of patients with advanced laryngeal or hypopharyngeal malignancy who underwent TL/TLP with contralateral hemi-thyroid and parathyroid gland preservation, between January 2012 and May 2019 were included in this study. Pre-operative thyroid/parathyroid function was assessed by estimation of blood levels of T3, T4, TSH and calcium. The same were evaluated at 1week and 6 weeks following surgery and 4 weeks following radiotherapy.  

Results: 72.7% patients developed hypothyroidism and only 22.7% developed hypocalcemia following surgery alone at the end of 6 weeks post-surgery. 60% developed hypothyroidism and 10% had hypocalcemia in the group of patients who underwent surgery followed by radiotherapy.

Conclusions: Preservation of contralateral hemi-thyroid with parathyroid glands, significantly reduces the incidence of hypoparathyroidism in patients undergoing TL/TLP. Though incidence of hypothyroidism in such cases is still high, reduced dose of thyroid hormone supplementation was achieved. Post-operative radiotherapy did not significantly alter the thyroid and parathyroid function in such cases.

 


Keywords


Total laryngectomy, Hypothyroidism, Hypoparathyroidism, Hypocalcemia, Laryngeal malignancy

Full Text:

PDF

References


Chung-Wai AH, Wai-Kuen H, Kin-Yip PL. Thyroid dysfunction in laryngectomees - 10 years after treatment; Head and Neck; 2008.

Sparano A, Chernock R, Laccourreye O. Predictors of thyroid gland invasion in glottic squamous cell carcinoma. Laryngoscope. 2005;115:1247-50.

Hancock, SLMcDougall, IRConstine LS. Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol Biol Phys. 1995;31(5):1165-70.

Galbo L, Kuik AM, Lips DJ. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma. Oral Oncol. 2013;49(9):950-5.

Galbo LAM, De Bree R, Kuik DJ. The prevalence of hypothyroidism after treatment for laryngeal and hypopharyngeal carcinomas: are autoantibodies of influence? Acta Otolaryngol. 2007;127:312-7.

Leon X, Gras JR, Perez A. Hypothyroidism in patients treated with total laryngectomy. A multivariate study. Eur Arch Otorhinolaryngol. 2002;259:193-6.

Negm H, Mosleh M, Fathy H, Eur AA. Thyroid and parathyroid dysfunction after total laryngectomy in patients with laryngeal carcinoma. Arch Otorhinolaryngol. 273(10):3237-41.

Dadas B, Uslu B, Cakir B. Intraoperative management of the thyroid gland in laryngeal cancer surgery. J Otolaryngol. 2001;30:179-83.

Sinard RJ, Tobin EJ, Ernest L. Hypothyroidism After Treatment for Nonthyroid Head and Neck Cancer. Arch Otolaryngol Head Neck Surg. 2000;126(5):652-7.

Dutta S, Biswas KD, Ghatak S. Post-operative hypofunctioning of the thyroid gland after total laryngectomy. Ear Nose Throat J. 2016;95(8):E23-7.

Garcia-Serra A, Amdur RJ, Morris CG. Thyroid function should be monitored following radiotherapy to the low neck. Am J Clin Oncol. 2005;28:255-8.

Isaacson SR, Snow JB. Etiologic factors in hypocalcaemia secondary to operations for carcinoma of the pharynx and larynx. Laryngoscope. 1978;88:1290-7.

Bhandare N, Kennedy L, Malyapa R. Primary and central hypothyroidism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys. 2007;68:1131-9.

Tell R, Lundell G, Nilsson B. Long-term incidence of hypothyroidism after radiotherapy in patients with head-and-neck cancer. Int J Radiat Incol Biol Phys. 2004;60:395-400.

Tsukahara KK, Motohashi R. Extent of thyroid resection and thyroid function after postoperative radiotherapy following total laryngectomy or total pharyngolaryngoesophagectomy. Japan Society Clin Oncol; 2017.

Ozawa H, Saitou H, Mizutari K. Hypothyroidism after radiotherapy for patients with head and neck cancer. Am J Otolaryngol. 2007;28:46-9.

Nishiyama K, Tanaka E, Tarui Y. A prospective analysis of subacute thyroid dysfunction after neck radiation. Int J Radiat Oncol Biol Phys. 1996;34:439-44.

Hall EJ, Cox JD. Physical and biologic basis of radiation therapy. In: Cox JD (ed) Moss radiation oncology rationale, technique, results. Mosby Co, St Louis; 1994:1-66.