Risk Factors For Hypothyroidism After Surgery For Pituitary Tumors

Objective:This study aims to study the risk factors for hypothyroidism after surgery for pituitary tumors,and provide a reference and basis for the postoperative treatment of patients with pituitary tumors,so as to reduce the incidence of hypothyroidism in patients with pituitary tumors,correct hypothyroidism in time,and improve the quality of life of patients with pituitary tumors after surgery.Methods:The clinical data of 432 patients with pituitary tumors admitted to the Department of Neurosurgery of our hospital from January 2020 to December 2022 were collected,and the effects of gender,age,recurrence,stroke,surgical method,Knosp grade,tumor location,blood supply,underlying disease,pituitary tumor type,and pituitary tumor size on the incidence of hypothyroidism after pituitary tumor surgery were analyzed.The subjects were all patients treated with surgery and preoperative head MRI and postoperative examination suggesting pituitary tumors,and thyroid function was monitored after surgery.SPSS20.0 software was used for data analysis,chi-square test was used for the test of rate or composition ratio between the two groups,t-test was used for the comparison of mean between the two groups,and logistic regression analysis was used for the analysis of postoperative hypothyroidism risk factors,with P less than 0.05 as the statistically significant criterion.Results:The clinical data of 432 patients with pituitary tumors who underwent surgery were statistically analyzed,including 216 male patients and 216 female patients.There were 69 cases under 40 years of age,257 cases between 40 and 60 years old,and 103 cases over 60 years old.Postoperative review of thyroid function showed hypothyroidism in 152 patients.Among them,87 cases were male,accounting for 40.27%,and 65 cases were female,accounting for 30.09%;Among the 44 cases of recurrent pituitary tumors,25 cases had postoperative hypothyroidism,accounting for 56.82%.Among the 388 non-recurrent pituitary tumors,127 had postoperative hypothyroidism,accounting for 32.73%.Among the 23 cases of craniotomy,16 patients had postoperative hypothyroidism,accounting for69.57%,13 patients had postoperative hypothyroidism,accounting for 68.42%,and 123 patients had postoperative hypothyroidism in 390 neuroendoscopic operations,accounting for 31.54%.Among the 134 patients with underlying diseases such as hypertension and diabetes,59 had postoperative hypothyroidism,accounting for 44.03%,and among 298 patients without underlying diseases such as hypertension and diabetes,93 had postoperative hypothyroidism,accounting for 31.21%;Among the 87 patients with pituitary tumor with tumor,43 cases had postoperative hypothyroidism,accounting for49.43%,and 345 patients with pituitary tumor without stroke had postoperative hypothyroidism,accounting for 31.59%.There were 103,20,18 and 11 cases of hypothyroidism after surgery for gonadotropin-type,adrenocorticotropic hormone(ACTH),prolactin type and growth hormone pituitary tumor,with the incidence rates of34.80%,42.55%,39.13% and 25.58%,respectively.There were 89 cases of pituitary tumors located in the sella alone,16 cases of postoperative hypothyroidism,accounting for17.98%,343 cases of pituitary tumors located in other parts such as sella,suprasellar pool,and parasellar area,and 136 cases of postoperative hypothyroidism,accounting for39.65%.There were 16,82 and 54 cases of hypothyroidism after surgery for general,moderate and abundant pituitary tumors,with incidence rates of 55.17%,30.48% and40.30%,respectively.There were 82,13,43 and 14 cases of hypothyroidism in Knosp grade 1,2,3 and 4,accounting for 32.03%,33.33%,41.35% and 42.42%,respectively.Chi-square test analysis showed that pituitary tumor type and Knosp grade were not statistically significant,that is,pituitary tumor type and Knosp grade were not influencing factors of hypothyroidism after pituitary tumor surgery,and t-test analysis showed that age was not statistically significant,that is,age was not an influencing factor affecting hypothyroidism after pituitary tumor surgery,recurrence,gender,stroke,location,underlying disease,surgical method,pituitary tumor size and whether hypothyroidism occurred,that is,the P value obtained was less than 0.05.The T3 or T4 lower than normal after surgery was judged as hypothyroidism,T3 and T4 were both normal and normal,and the factors significant in univariate analysis were used as independent variables for logistic regression analysis,and the results showed that male,recurrence,sella combined with others,large pituitary tumors,and underlying diseases were risk factors for postoperative hypothyroidism,and compared with endoscopic surgery,microscopy and craniotomy could significantly increase the risk of postoperative hypothyroidism.Conclusion:1.Age was not statistically significant for hypothyroidism after pituitary tumor surgery;2.Sex-determining incidence of hypothyroidism after pituitary tumor surgery,the prevalence of men is higher than that of women;3.Relapse,stroke,location,size of pituitary tumor,underlying diseases such as hypertension and diabetes and surgical methods are important influencing factors of hypothyroidism after surgery for pituitary tumors;That is,if it is a patient with recurrent pituitary tumor with stroke,combined with hypertension or diabetes,large pituitary tumor,extensive pituitary tumor,and craniotomy,the probability of hypothyroidism after surgery is high.