Prescription Pattern and Clinical Outcomes Following Surgical Management of Thyroid Disorders

Background: Thyroid disorders represent a major global public health concern, frequently requiring surgical intervention such as total thyroidectomy or hemithyroidectomy. Postsurgical care demands precise pharmacological management to replace hormone deficits, manage hypocalcemia, and mitigate postoperative complications. However, variations in prescription patterns across surgical interventions and their corresponding long-term clinical outcomes remain inadequately characterized in clinical practice.

Objective: To evaluate post-thyroidectomy prescription patterns; specifically thyroid hormone replacement and calcium/vitamin-D supplementation, and their correlation with clinical outcomes, biochemical homeostasis, and postoperative complication rates over a 12-month follow-up period.

Methods: A prospective observational cohort study was conducted involving 210 patients who underwent surgical management for benign or malignant thyroid disorders across multiple tertiary care hospitals over a 2-year period. Demographic profiles, surgical extensions (Total Thyroidectomy vs. Hemithyroidectomy), histopathological diagnoses, post-discharge medication regimens, and serial biochemical markers (serum TSH, free T4, serum total and ionized calcium, parathyroid hormone) were recorded at baseline, 1, 3, 6, and 12 months post-surgery. Clinical outcomes assessed included rate of biochemical euthyroid state achievement, incidence of symptomatic or biochemical hypocalcemia, medication adherence, and hospital readmissions.

Results: Of the 210 patients (mean age 46.8 ± 11.4 years; 81.4% female), 142 (67.6%) underwent total thyroidectomy (TT) and 68 (32.4%) underwent hemithyroidectomy (HT). Levothyroxine (L-T₄) was prescribed to 100% of TT patients and 38.2% (n=26) of HT patients. The mean initial dosing of L-T₄ post-total thyroidectomy was 1.52 ± 0.24 μg/kg/day. At 12 months, 78.2% of TT patients achieved target serum TSH levels (0.5 - 2.5 μIU/mL for benign; <0.1 μIU/mL for high-risk malignant cases). Prophylactic calcium and calcitriol supplementation was initiated in 83.1% of TT patients versus 14.7% of HT patients. Postoperative transient hypocalcemia occurred in 28.2% of TT patients, whereas permanent hypoparathyroidism/hypocalcemia developed in 3.5% of TT cases. Weight-based L-T₄ initiation correlated significantly faster with target TSH attainment compared to fixed empirically-dosed regimens (p < 0.001). Adherence to LT4 therapy strongly predicted overall biochemical stability OR = 4.12, 95% CI: 2.15 - 7.89, p < 0.001).

Conclusion: Standardized, weight-based Levothyroxine dosing following total thyroidectomy significantly improves the rate of early euthyroid stabilization. Early, routine calcium and active vitamin D supplementation reduces post-thyroidectomy hypocalcemic crisis and hospital readmissions. Pharmacotherapy optimization tailored to surgical extent and histopathological risk is essential to maximize clinical outcomesin thyroid disorder management