Factors associated with hypothyroidism following hemithyroidectomy: a prospective study

Authors

  • Sanathorn Chowsilpa Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Thailand
  • Rak Tananuvat Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Thailand

Keywords:

hemithyroidectomy, hypothyroidism, high normal pre-operative TSH level

Abstract

Objective To assess the incidence of post-operative hypothyroidism after hemithyroidectomy in the Thai population living in the northern region of Thailand and to analyze factors associated with hypothyroidism following hemithyroidectomy.

Methods A prospective study was conducted at Chiang Mai University Hospital, Thailand, of patients who had thyroid nodules and who were scheduled for a hemithyroidectomy between September 2010 and April 2012. Patients were divided into a euthyroid group and a hypothyroid group. Demographic data, pre- and post-operative thyroid function tests, resected side, weight, and pathological diagnosis of resected thyroids were analyzed.

Results Of the 50 cases, 11 patients who had documented malignancy and required total thyroidectomy and those who were lost to follow up were excluded. The study included 39 cases (7 males and 32 females) age 19 to 71 years (average 46.9±13.8 years). Left and right hemithyroidectomies were done in 25 and 14 patients, respectively. Pathology reports on the patients indicated adenomatous goiter (66.6%), follicular adenoma (20.5%), colloid cyst (5.1%), Hurthle cell adenoma (2.6%), chronic lymphocytic thyroiditis (2.6%), and nodular goiter with lymphocytic thyroiditis (2.6%). Eight cases (20.5%) had developed hypothyroidism at eight to ten weeks postoperatively. The preoperative TSH level of the hypothyroid group was normal, but signi fi cantly lower than in the euthyroid group (p =0.009). Age, pre-operative free T4 and free T3, weight, and resected side were not signifi cantly different between the two groups. More male patients than females developed post-operative hypothyroidism (42.9% VS 15.6%), although the difference was not statistically signi fi cant.

Conclusions As one- fi fth of the hemithyroidectomy patients developed hypothyroidism within eight to ten weeks post-operatively, clinicians should be alert for post-operative hypothyroidism and provide prompt treatment, particularly in patients with a pre-operative high normal TSH level.

References

Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2009;19: 1168-214.

Pellitteri PK, Ing S, Jameson B. Disorders of the Thyroid Gland. In: Flint PW, Haughey BH, LundVJ, et al, editors. Otolaryngology head and neck surgery. 5th ed. Philadelphia: Elsevier Mosby; 2010. p. 1735-50.

Piper HG, Bugis SP, Wilkins GE, Walker BA, Wiseman S, Baliski CR. Detecting and defi ning hypothyroidism after hemithyroidectomy. Am J Surg. 2005;189:587-91.

Moon HG, Jung EJ, Park ST, Jung TS, Jeong CY, Ju YT, et al. Thyrotropin level and thyroid volume for prediction of hypothyroidism following hemith-yroidectomy in an Asian patient cohort. World J Surg. 2008;32:2503-8.

McHenry CR and Slusarczyk. Hypothyroidism fol-lowing hemithyroidectomy: Incidence, risk factors and management. Surgery. 2000;128:994-8.

Wormald R, Sheahan P, Rowley S, et al. Hemithy-roidectomy for benign thyroid disease: who needs follow-up for hypothyroidism?. Clin Otolaryngol. 2008;33:587-91.

Stoll SJ, Pitt SC, Liu J, Schaefer S, Sippel RS, Chen H.Thyroid hormone replacement after thy-roid lobectomy. Surgery. 2009;146: 554-60.

Miller FR, Paulson D and Prithoda TJ. Risk fac-tors for the development of hypothyroidism after hemithyroidectomy. Arch Otolaryngol Head Neck Surg. 2006;132:36-8.

Seiberling KA, Dutra JC and Bajaramovic S. Hy-pothyroidism following hemithyroidectomy for be-nign nontoxic thyroid disease. Ear Nose & Thraot J. 2007;86:295-9.

De Carlucci D Jr, Tavares MR, Obara MT, Martins LA, Hojaij FC, Cernea CR. Thyroid function after unilateral total lobectomy. Arch Otolayngol Head Neck Surg. 2008;134:1076-9.

Vaiman M, Nagibin A, Hagag P, Kessler A, Gavriel H. Hypothyroidism following partial thyroidectomy. Otolaryngol Head Neck Surg. 2008;138:98-100.

Koh YW, Lee SW, Choi EC, Lee JD, Mok JO, Kim HK, et al. Prediction of hypothyroidism after hemithyroidectomy: a biochemical and patho-logical analysis. Eur Arch Otorhinolaryngol. 2008; 265:453-7.

Su SY, Groski S, Serpell JW. Hypothyroidism fol-lowing hemithyroidectomy: A retrospective review. Ann Surg. 2009;250:991-4.

Chotigavanich C, Sureepong P, Ongard S, Eiam-kulvorapong A, Boonyaarunnate T, Chongkolwa-tana C, et al. Hypothyroidism after Hemithyroid-ectomy: The Incidence and Risk Factors. J Med Assoc Thai. 2016;99:77-83.

Buchanan MA, Lee D. Thyroid auto-antibodies, lymphocytic infi ltration and the development of postoperative hypothyroidism following hemithy-roidectomy for non-toxic nodular goiter. J R Coll Surg Edin. 2001;46:86-90.

Downloads

Published

2017-10-01

How to Cite

1.
Chowsilpa S, Tananuvat R. Factors associated with hypothyroidism following hemithyroidectomy: a prospective study. BSCM [Internet]. 2017 Oct. 1 [cited 2024 Mar. 29];56(4):195-201. Available from: https://he01.tci-thaijo.org/index.php/CMMJ-MedCMJ/article/view/106655

Issue

Section

Original Article