Post Hemi Thyroidectomy Hypothyroidism: Risk Factors and Course
Abstract
Background: Risk factors for post hemithyroidectomy (HT) biochemical hypothyroidism (BH) and its course are not well understood. The aim of the study was to look at the incidence, risk factors and the course of BH after HTMaterial and Methods: Longitudinal observational study at a tertiary care referral centre. Patients undergoing HT (Jan to Dec 2009), having a follow up for 2 years, with no history of head and neck radiation and euthyroid pre op status were included. Serum TSH, FT4, TPO Ab, Anti Tg Ab, FNAC and USG thyroid are performed pre operatively. Post operatively the residual thyroid volume was assessed using USG at 1 week. TSH was performed at one, three, six, twelve months after surgery.Statistical analysis: SPSS vs. 12 used and appropriate statistical tests appliedResults: Patients (n=92) satisfied the inclusion criteria (14 males and 78 females). The mean age, duration of the goiter, TPO Ab and serum Anti Tg Ab levels were 38.58±9.98 years, 35.08±49.39 months, 43.87 ± 85.7 IU/mL and 2.65 ± 2.28 IU/mL respectively. BH was observed in 43.48% (n=40). Patients who had BH after HT were older, had significantly lower residual thyroid volume and smaller sized involved lobe. Patients with thyroiditis had a relative risk of 1.97 for post operative BH. At one year 23.33% (n=21) had BH.Conclusions: Post hemithyroidectomy BH is common in older patients with lesser amount of residual thyroid volume. 50% of these recover spontaneously within the first year after surgery necessitating monitoring of thyroxine replacementReferences
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2)Pradeep PV. State of the art: Surgery for Endemic goiter. Langenbecks Arch Surg. 2012 Mar;397(3):491-2
3)Pradeep PV, Gouru V. Surveillance and intervention after thyroid lobectomy. Ann Surg Oncol. 2011 Dec;18 Suppl 3:S308
4)Wan Chu KK, Lang BH. Clinicopathologic predictors for early and late biochemical hypothyroidism after hemithyroidectomy. Am J Surg 2012;203:461-66
5)Surks MI, Ortiz E, Daniels GH et al. Subclinical thyroid disease: scientific review and guidelines for the diagnosis and management. JAMA 2004;291:228-38
6)McHenry CR, Slusarczyk SJ. Hypothyroidism after HT: incidence, risk factors and management. Surgery 2000;128:994-8
7)Kapil U, Singh P. Status of iodine content of Salt and urinary iodine excretion levels in India. Pak J Nutrition 2003;2:361-73
8)Shabana W, Peeters E, Maeseneer MD. Measuring thyroid gland volume: Should we change the correction factor? AJR 2006;186:234-36
9)Moon HG, Jung EJ, Park ST, Jung TS, Jeong CY, Ju YT, Lee YJ, Hong SC, Choi SK, Ha WS. Thyrotropin level and thyroid volume for prediction of hypothyroidism following hemithyroidectomy in an Asian patient cohort. World J Surg 2008;32:2503-08
10)McHenry CR, Slusarccyzk SJ. Hypothyroidism following hemithyroidectomy: incidence, risk factors and management. Surgery 2000;128:994-98
11)Piper HG, Bugis SP, Wilkins GE. Detecting and defining hypothyroidism after hemithyroidectomy. Am J Surg 189:587-591
12)Miller FR, Paulson D, Prihoda TJ. Risk factors for development of hypothyroidism after hemithyroidectomy. Arch Otolaryngol Head and Neck Surg 2006;132:36-38
13)Su SY, Grodski S, Serpell JW. Hypothyroidism following hemithyroidectomy: a retrospective review. Ann Surg 2009;250:991-94
14)Vanderpump MP, Tunbridge WM, French JM. The incidence of thyroid disorders in the community: a twenty year follow up of the Whickham survey. Clin Endocrinol 1995;43:55-68
