Volume 31, Issue 1 (3-2024)                   RJMS 2024, 31(1): 1-8 | Back to browse issues page

Research code: IR.IUMS.FMD.REC.1399.650
Ethics code: IR.IUMS.FMD.REC.1399.650

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Ghanbari H, Jahandideh H, Rajaeih S, Afra H. Exploring the Correlation between Thyroid Hormones and Post-Rhinoplasty Nasal Edema: A Prospective Cohort Study. RJMS 2024; 31 (1) :1-8
URL: http://rjms.iums.ac.ir/article-1-8080-en.html
Research Assistant Professor, ENT& Research Center and Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (95 Views)
Background & Aims: Rhinoplasty is a joint facial surgery that can lead to various complications, including bleeding, edema, and ecchymosis. Many surgeons have shifted towards less invasive surgical techniques to reduce these risks. However, there is insufficient research on the impact of thyroid hormones on post-surgery outcomes. This study aims to assess the effects of two specific thyroid hormones, T4 and TSH, on postoperative edema in rhinoplasty patients. By identifying the role of these hormones, we can enhance patient satisfaction and improve recovery times.
Methods: This prospective cohort study was conducted in 2022 on patients referred to the Ear, Nose, and Throat Clinic (ENT) of Rasool Akram Hospital, Tehran, Iran. Before participating, all study candidates were required to sign a written consent form; those who declined were excluded from the study. The protocol received approval from the ethics committee and review board of the Iran University of Medical Sciences (Ethics Code=1399.650). This investigation aimed to measure the levels of two thyroid hormones-thyroxine (T4) and thyrotropin (TSH). We conducted hormone assessments in the first week after the surgery, followed by weekly measurements up to the fourth week. We collected blood samples from each patient at each time point for hormone level evaluations. Additionally, we collected data on potential confounding factors such as age, sex, and body weight. The primary outcome of interest was postoperative edema. Post-surgery edema was assessed using the Visual Analogue Scale (VAS) and physician assessments, which were repeated weekly until the fourth week. The recovery speed was determined by subtracting the VAS score in the first week from the score in the fourth week. Initially, we verified the normality of each variable by employing the Kolmogorov-Smirnov test. We presented the mean and standard deviation for variables adhering to a normal distribution. Variables that deviated from normality were described using the median and interquartile range. Dichotomous variables were reported as the frequency and percentage. Pearson correlation coefficients were utilized to explore the correlation between VAS scores and hormone levels. The relationship between changes in hormone levels and the rate of edema recovery was also examined using the Pearson correlation. All statistical analyses were conducted using SPSS software version 22.0, with a statistical significance threshold set at 0.05.
Results: The study included 58 patients from Rasul Akram Hospital's ear, nose, and throat clinic. The participants had a mean age of 36.3 years with a standard deviation of 6.8 years, and 74.1% were women. Their mean weight was 64.5 kg, with a standard deviation (SD) of 8.9 kg. The mean serum level of thyroxine (T4) was reported at 7.9±1.4, and the mean level of thyroid-stimulating hormone (TSH) was 3.4±1.9.
Table 2 highlighted the progression of nasal edema as measured by the VAS from the patient's and the doctor's perspectives. Initially, patients reported a mean VAS score of 8.5 (SD = 1.0), gradually decreasing to 4.9 (SD = 1.4) by the fourth week. Doctors observed a similar downward trend in VAS scores, starting from 7.7 (SD = 0.8) in the first week to 4.5 (SD = 1.4) in the fourth week. The average rate of edema reduction was calculated at 1.2 (SD = 0.3). The analysis explored the correlation between thyroid hormone levels and VAS scores. Pearson's correlation coefficient showed no statistically significant correlation between T4 levels and VAS scores during the study (P-value>0.05). Although there was a slight positive correlation between T4 levels and the rate of edema reduction, it was not statistically significant (P-value=0.079). Conversely, a significant positive correlation was found between TSH levels and VAS scores, indicating that higher TSH levels were associated with increased nasal edema. In the first week, this correlation was significant (Pearson correlation coefficient=0.378, P-value=0.003), intensifying in the second week (coefficient=0.454, P-value<0.001), and remained highly significant in the third and fourth weeks (coefficients=0.565 and 0.559, respectively, P-value<0.001). Additionally, a higher TSH level negatively correlated with the rate of edema reduction, suggesting that increased TSH levels could delay recovery from edema (correlation coefficient=-0.542, P-value<0.001).
Conclusion: Various factors can cause complications after a rhinoplasty. Although medical treatments like steroid medications and surgical techniques have been studied for their impact on postoperative swelling, the potential role of thyroid hormones has yet to be explored as much. This study investigates the influence of thyroxine (T4) and thyrotropin (TSH) on edema after rhinoplasty for four weeks. The study also aims to determine how these hormones affect the rate at which edema resolves. Our analysis found no significant correlation between T4 levels and postoperative edema but a suggestive trend towards a positive association with the rate of edema reduction. The lack of significant T4 findings contrasts with the notable effects of TSH, suggesting a more complex impact of thyroid hormones on surgical recovery. These findings underscore the importance of further research to reveal the potential underlying biological mechanism that T4 might have in the healing process. High TSH levels are associated with postoperative edema, which suggests that thyroid function plays a role in surgical recovery. TSH could be used as a biomarker to manage postoperative healing outcomes. Previous studies show a link between hypothyroidism and the exacerbation and prolongation of inflammatory responses. Kinoshita et al. found that changes in thyroid hormone levels can lead to edema formation. This connection highlights the role of thyroid hormones in fluid regulation, suggesting that they play a crucial role in modulating the extracellular fluid dynamics that underpin edema.
Langsdon et al. have linked hypothyroidism to extended edema in patients undergoing facial surgery. This and our research suggest a broader systemic effect of thyroid hormone levels on tissue healing and fluid balance. Evidence indicates the thyroid regulates postoperative recovery, especially in surgeries where tissue disruption and inflammation can lead to significant edema. More significant multicenter studies are needed to provide a more diverse patient population and a broader range of surgical techniques and postoperative care protocols. Additionally, it is essential to consider potential confounding factors that need to be fully accounted for in this study. Some of these factors include pre-existing health conditions, medication use, nutritional status, and lifestyle choices such as smoking and alcohol consumption, which can affect hormone levels and the body's response to surgery. Given the complexity of post-surgical recovery, which physiological and psychological factors can influence, a multifactorial approach is necessary to understand the role of thyroid hormones in this process. Therefore, future studies should aim to control for these confounders through careful study design and statistical analysis.
High TSH levels worsen post-rhinoplasty edema, while T4 levels show a non-significant trend toward faster recovery. More multicenter studies are needed to determine thyroid hormones' effects on postoperative edema.
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Type of Study: Research | Subject: ENT Surgery

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