Hypothyroidism Following Hemithyroidectomy

Abstract

An incidence of 10.9% is higher than anticipated and all patients should have postoperative thyroid function assessment. However, a high-normal preoperative TSH, elevated thyroid antibody levels, and the presence of thyroiditis on histology are indications for close monitoring.

Hypothyroidism After Hemithyroidectomy: Incidence, Risk Factors, Natural History and Management

“…The reported incidence of hypothyroidism after hemithyroidectomy has been found to vary from 5.0% to 49%, with most studies reporting a range of 15-30% (Wormald et al, 2008;Chu et al, 2011;Su et al, 2009;Spanheimer et al, 2011). This disparity in results is partially due to differences in their definition of hypothyroidism and to differences in length of follow-up.…”

“…The possibility of compensatory hypertrophy of the residual lobe should be balanced by the need for close follow-up of patients with borderline thyroid reserves, and the potential for deterioration at times of physiological stress and progression of underlying thyroiditis. Routine thyroxine replacement may be recommended, rather than close follow-up monitoring, for some posthemithyroidectomy patients with risk factors, such as elevated thyroid antibody concentrations or histologic evidence of autoimmune thyroiditis (Su et al, 2009). In contrast, other researchers have reported that elevated serum TSH concentration alone may not justify the initiation of thyroid hormone replacement, since nearly 70% of individuals who developed biochemical (asymptomatic) hypothyroidism during the early postoperative period after hemithyroidectomy recovered normal thyroid function without pharmacologic intervention (Johner et al, 2011).…”

“…Su, et al (2009) TSH monitoring at 6 months, 12 months, and then yearly for 2 years was recommended for asymptomatic patients. High-risk patients should have serial TSH for the first year, then yearly thereafter.…”

Contralateral Lobe Volume Brings Us One Step Closer to the Prediction of Hypothyroidism Following Partial Thyroid Resection

“…2 These findings strengthen the observations by De Carlucci et al regarding the importance of remnant volume, 3 and are concordant with the existing body of literature that has demonstrated the presence of antithyroid peroxidase antibodies, thyroiditis, a multinodular goiter, preoperative thyrotoxicosis, and a TSH level within the high-normal range to be associated with the development of biochemical hypothyroidism following hemithyroidectomy. [3][4][5][6][7] Despite the novel approach to risk-stratify patients regarding the development of biochemical hypothyroidism, the paper does not solve the problem of predicting clinically significant hypothyroidism (i.e. hypothyroidism requiring treatment) as most postoperative biochemical hypothyroidism resolves spontaneously.…”

“…[3][4][5][6][7] Despite the novel approach to risk-stratify patients regarding the development of biochemical hypothyroidism, the paper does not solve the problem of predicting clinically significant hypothyroidism (i.e. hypothyroidism requiring treatment) as most postoperative biochemical hypothyroidism resolves spontaneously.…”