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. 2024 Mar 4;18(1):108.
doi: 10.1007/s11701-024-01869-y.

TSH receptor antibody as a predictor of difficult robotic thyroidectomy in patients with Graves' disease

Ja Kyung Lee  1 , Yoon Kong  1 , Jae Bong Choi  1 , Woochul Kim  2 , Hyeong Won Yu  1   3 , Su-Jin Kim  2   3 , Young Jun Chai  3   4 , June Young Choi  5   6 , Kyu Eun Lee  2   3
Affiliations

TSH receptor antibody as a predictor of difficult robotic thyroidectomy in patients with Graves' disease

Ja Kyung Lee et al. J Robot Surg. .

Abstract

Thyroidectomy in Graves' disease can be challenging due to greater thyroid size and vascularity. While thyroid stimulating hormone receptor antibody (TRAb) level is associated with disease severity and thyroid vascularity, its impact on operative outcomes remains unclear. This study aimed to compare challenging factors for robotic thyroidectomy (RT) and open thyroidectomy (OT) in Graves' disease patients, including TRAb as a predictive factor for difficult thyroidectomy. This retrospective study included Graves' disease patients who underwent total thyroidectomy between September 2013 and January 2023. The clinical characteristics and operative outcomes were compared between patients who received OT and bilateral axillo-breast approach RT. Factors affecting operation time and estimated blood loss (EBL) were evaluated in both groups using regression analyses. A total of 85 patients received either OT (n = 48) or RT (n = 37). Median thyroid volumes in the OT and RT groups were 72.4 g and 57.6 g, respectively. Operation time was affected by thyroid volume in both groups. Additionally, higher thyroid hormone levels and bilateral central neck node dissection prolonged operation time in the RT group. EBL was marginally associated with thyroid volume in the OT group. However, in the RT group, TRAb level was independently associated with greater EBL (p = 0.04), while no significant association was found with thyroid volume. Predictive factors for difficult thyroidectomy differed by operation approaches. TRAb significantly predicted intraoperative bleeding in RT, while this association was absent in OT. Caution is warranted when performing RT on Graves' disease patients with high TRAb levels.

Keywords: Difficult thyroidectomy; Graves’ disease; Intraoperative blood loss; Operation time; Robotic thyroidectomy; Thyroid stimulating hormone receptor antibody.

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Conflict of interest statement

The authors declare no funds, grants, or other support for the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Comparisons of (A) Thyroid volume and (B) TSH receptor antibody by EBL. OT open thyroidectomy, RT robotic thyroidectomy, EBL estimated blood loss, TRAb thyroid stimulating hormone receptor antibody, n.s not significant
See this image and copyright information in PMC

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