Clinical Thyroidology® for the Public

Summaries for the Public from recent articles in Clinical Thyroidology
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THYROID SURGERY
Patients undergoing thyroid surgery: Impact of body weight on postsurgical outcomes:

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BACKGROUND
The rates of obesity are increasing in the general population and many of these patients require surgery. There has been considerable research evaluating surgical outcomes in obese patients with mixed results. Higher rates of postoperative complications are reported with a high body-mass index (BMI) in the overweight and obese range. However, some studies have shown that patients with moderate obesity (BMI 25-35) may actually have better surgical outcomes as compared to patients with a BMI of <25 or >35.

In thyroid surgery, there have been conflicting results regarding outcomes in obese patients. The aim of this study was to examine the effect of increasing BMI on outcomes following thyroid surgery.

THE FULL ARTICLE TITLE
 Armstrong VL et al Thyroidectomy outcomes in obese patients. J Surg Res 2024;295:717-722; doi: 10.1016/j. jss.2023.11.071. PMID: 38142574.

SUMMARY OF THE STUDY
The medical records of patients >18 years who underwent thyroid surgery between January 2015 and December 2018 were reviewed. The patients were divided into the following groups: Underweight (BMI, <18.5), normal (BMI, 18.5–24.9), pre-obesity (BMI, >25–29.9), class 1 obesity (BMI, 30–34.9),

class II obesity (BMI, 35 to >39.5), and class III obesity (BMI, >40). Patients were also divided into two groups: those with a BMI ≥40 and those with a BMI <40.

A total of 465 patients were included; the majority were female. There was no significant difference regarding length of stay, operating room time or return to the operating room.

This study showed that BMI was not a factor in the rate of complications after thyroid surgery. However, the rate of postoperative infections, pneumonia and hospital readmission at a later date were higher in patients with a higher BMI. There was no difference in outcomes between patients undergoing total thyroidectomy or hemithyroidectomy.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that thyroid surgery is safe for patients regardless of their BMI, although patients at the higher BMIs may be at risk for infections after surgery. A larger study may help us understand postoperative outcomes in patients undergoing thyroid surgery better.

— Vibhavasu Sharma, MD

ABBREVIATIONS & DEFINITIONS

Total thyroidectomy: surgery to remove the entire thyroid gland.

Partial thyroidectomy: surgery that removes only part of the thyroid gland (usually one lobe with or without the isthmus).

Body-mass index (BMI): a standardized measure of obesity calculated by dividing the weight in kilograms by the square of the height. A normal BMI is 18.5-24.9, overweight is 25-30 and obese is >30.

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