Hemithyroidectomy: A Meta-Analysis of Postoperative Need for Hormone Replacement and Complications

Abstract

Background: We sought to determine certain factors predicting postoperative need for hormone replacement therapy (HRT) after hemithyroidectomy. Methods: A PubMed search was conducted to identify articles with separate cohorts for total and hemithyroidectomy. Outcomes of interest included hypothyroidism and complications. Results: Of 50,445 patients, 15,412 (30.6%) underwent hemithyroidectomy. The reported incidence rate of postoperative hypothyroidism was 10.9-48.8%. The pooled mean preoperative thyroid-stimulating hormone (TSH) level was 1.06 µIU/l (0.83-1.29) higher in hypothyroid patients. A preoperative TSH level >2.5 µIU/l was associated with a relative risk (RR, 95% CI) of 3.16 (2.03-4.90) for postoperative hypothyroidism. There was a significant pooled RR of 3.52 (2.55-4.86) for thyroid antibodies and 3.30 (2.49-4.36) for thyroiditis on pathology for postoperative HRT. The pooled RR for postoperative complications was 10.67 (5.75-19.31) for temporary hypocalcemia, 3.17 (1.72-5.83) for permanent hypocalcemia, 1.69 (1.30-2.20) for temporary injury to the recurrent laryngeal nerve (RLN), 1.85 (1.28-2.69) for permanent RLN injury and 2.58 (1.69-3.93) for hemorrhage in patients who underwent total thyroidectomy compared to hemithyroidectomy. Conclusion: Higher preoperative TSH levels, presence of anti-thyroid antibodies and thyroiditis predict postoperative need for HRT. It is imperative to counsel patients with these findings regarding their higher risk of developing postoperative hypothyroidism and need for HRT after hemithyroidectomy.

Predictors of thyroxine replacement following hemithyroidectomy in a south east Asian cohort

“…A higher TSH preoperatively in patients undergoing a hemithyroidectomy indicates a lower thyroid function reserve and tend to develop hypothyroidism. A recent meta‐analysis showed that patients with a preoperative TSH above 2.5 μIU/L are three times (RR: 3.16) more likely to develop hypothyroidism postoperatively . In our study preoperative TSH above 2.5 significantly did not predict for postoperative hypothyroidism, unlike other studies.…”

Papillary thyroid microcarcinoma: decision-making, extent of surgery, and outcomes

“…We found no significant difference in the rate of permanent complications when we compared those with pre- versus postoperatively diagnosed PTMC; however, the study was significantly underpowered to detect a difference in outcomes. Larger studies of patients undergoing thyroid surgery demonstrate appreciably higher risks of permanent complications for TT compared to TL (10, 35). While these rates tend to be low, the risk of complications is higher in low-volume surgeons who perform the majority of thyroid surgery in the United States.…”

Frequency of High-Risk Characteristics Requiring Total Thyroidectomy for 1–4 cm Well-Differentiated Thyroid Cancer

“…First, lobectomy is inherently associated with lower operative risks than TT, particularly related to postoperative hypoparathyroidism, although both operations are quite safe, particularly in high-volume surgeon/center settings. Although extremely rare, the devastating risk of bilateral recurrent laryngeal nerve injury requiring tracheostomy is avoided with lobectomy (9). Having a remaining lobe may also obviate the need for thyroid hormone replacement in more than half of patients when thyrotropin suppression may not be necessary (10).…”