Skip to main content

Advertisement

SpringerLink
Log in

Detection and Management of Hypothyroidism Following Thyroid Lobectomy: Evaluation of a Clinical Algorithm

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objectives of this study were to determine: (1) the incidence permanent hypothyroidism after thyroid lobectomy (TL), (2) whether asymptomatic patients with mildly elevated thyrotropin (TSH) levels can be managed without thyroid hormone replacement, and (3) if the degree of lymphocytic infiltration (LI) and germinal center (GC) formation in the resected thyroid lobe correlates with the development of post-TL hypothyroidism.

Methods

Subjects undergoing TL between January 2006 and January 2008 at 2 centers were enrolled in the study and thyroid function was followed prospectively based on a previously published algorithm. The histology of each resected thyroid lobe was examined, and the degree of LI and GC was quantified.

Results

The study cohort consisted of 117 patients. Early postoperative TSH levels were significantly increased over preoperative levels (P < .001). TSH measured at 6 months to 1 year postoperatively, while still significantly increased over preoperative levels (P < .001), was also significantly reduced (P = .006) compared with early postoperative levels. Of the patients who presented with early postoperative hypothyroidism, 69.2% recovered to normal levels without intervention. The overall incidence of early postoperative hypothyroidism was 21.6%, and permanent hypothyroidism was 7.8%. A high degree of LI and GC correlated with a significantly higher mean TSH level (P = .003).

Conclusions

The incidence of hypothyroidism following TL is low, and a significant proportion of individuals who become biochemically hypothyroid will demonstrate only a transient elevation in their TSH levels. As well, individuals with LI, or GC formation, within their resected thyroid lobe may be at increased risk for post-TL hypothyroidism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;235:794–800.

    Article  Google Scholar 

  2. 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;19:1167–214.

    Article  PubMed  Google Scholar 

  3. Lee YH, Lee NJ, Kim JH, Suh SI, Kim TK, Song JJ. Sonographically guided fine needle aspiration of thyroid nodule: discrepancies between cytologic and histopathologic findings. J Clin Ultrasound. 2008;36:6–11.

    Article  PubMed  Google Scholar 

  4. Mendez W, Rodgers SE, Lew JI, Montano R, Solorzano CC. Role of surgeon-performed ultrasound in predicting malignancy in patients with indeterminate thyroid nodules. Ann Surg Oncol. 2008;15:2487–92.

    Article  PubMed  Google Scholar 

  5. Wiseman SM, Baliski C, Irvine R, Anderson D, Wilkins G, Filipenko D, et al. Hemithyroidectomy: the optimal surgical approach for individuals undergoing surgery for a cytological diagnosis of follicular neoplasm. Ann Surg Oncol. 2006;13:425–32.

    Article  PubMed  Google Scholar 

  6. Melck A, Bugis S, Baliski C, Irvine R, Anderson DW, Wilkins G, et al. Hemithyroidectomy: the preferred initial surgical approach for management of Hurthle cell neoplasm. Am J Surg. 2006;191:593–7.

    Article  PubMed  CAS  Google Scholar 

  7. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med. 1998;128:386–94.

    PubMed  CAS  Google Scholar 

  8. Biondi B, Filletti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab. 2005;1:32–40.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Su SY, Grodski S, Serpell JW. Hypothyroidism following hemithyroidectomy. Ann Surg. 2009;250:991–4.

    Article  PubMed  Google Scholar 

  11. Wormald R, Sheahan P, Rowley S, Rizkalla H, Toner M, Timon C. Hemithyroidectomy for benign thyroid disease: who needs follow up for hypothyroidism? Clin Otolaryngol. 2008;33:587–91.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Miller FR, Paulson D, Prihoda TJ, Otto RA. Risk factors for the development of hypothyroidism after hemithyroidectomy. Arch Otolaryngol Head Neck Surg. 2006;132:36–8.

    Article  PubMed  Google Scholar 

  14. Seiberling KA, Dutra JC, Bajaramovic S. Hypothyroidism following hemithyroidectomy for benign nontoxic thyroid disease. Ear Nose Throat J. 2007;86:295–9.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Berglund J, Bondeson L, Christensen SB, Tibblin S. The influence of different degrees of chronic lymphocytic thyroiditis on thyroid function after surgery for benign, non-toxic goitre. Eur J Surg. 1991;157:257–60.

    PubMed  CAS  Google Scholar 

  17. Cheung P, Boey J, Wong J. Thyroid function after hemithyroidectomy for benign nodules. World J Surg. 1986;10:718–23.

    Article  PubMed  CAS  Google Scholar 

  18. Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol. 1994;130:350–6.

    Article  PubMed  CAS  Google Scholar 

  19. Schlote B, Nowotny B, Schaaf L. Subclinical hyperthyroidism: physical and mental state of patients. Eur Arch Psychiatry Clin Neurosci. 1992;241:357–64.

    Article  PubMed  CAS  Google Scholar 

  20. Al-Abadi AC. Subclinical thyrotoxicosis. Postgrad Med J. 2001;77:29–32.

    Article  PubMed  CAS  Google Scholar 

  21. Burmeister LA, Flores A. Subclinical thyrotoxicosis and the heart. Thyroid. 2002;12:495–9.

    Article  PubMed  Google Scholar 

  22. Sinard RJ, Tobin EJ, Mazzaferri EL, Hodgson SE, Young DC, Kunz AL, et al. Hypothyroidism after treatment nonthyroid head and neck cancer. Arch Otolaryngol Head Neck Surg. 2000;126:652–7.

    PubMed  CAS  Google Scholar 

  23. McHenry CR, Slusarczyk SJ. Hypothyroidism following hemi-thyroidectomy: Incidence, risk factors and management. Surgery. 2000;128:994–8.

    Article  PubMed  CAS  Google Scholar 

  24. Buchanan MA, Lee D. Thyroid auto-antibodies, lymphocytic infiltration and the development of postoperative hypothyroidism following hemithyroidectomy for non-toxic nodular goiter. J R Coll Surg Edinb. 2001;46:86–90.

    PubMed  CAS  Google Scholar 

  25. Stoll SJ, Pitt SC, Liu J, Schaefer S, Sippel RS, Chen H. Thyroid hormone replacement after thyroid lobectomy. Surgery. 2009;146:554–8.

    Article  PubMed  Google Scholar 

  26. Lombardi G, Panze N, Lupoli, Leonello D, Carlino M, Minozzi M. Study of the pituitary-thyroid axis in euthyroid goiter after partial thyroidectomy. J Endrocrinol Investig. 1983;6:485–7.

  27. Campion L, Gallour G, Ruelland, Cloarec L, Allannic H. Lipid and thyroid changes after partial thyroidectomy: Guidelines for L-thyroxine therapy? Clin Chem. 1995;41:473–4.

  28. Clark OH, Lambert WR, Cavalieri RR, Rapoport B, Hammond ME, Ingbar SH. Compensatory thyroid hypertrophy after hemithyroidectomy in rats. Endrocrinology. 1976;99:988.

    Article  CAS  Google Scholar 

  29. Marine D. Control of compensatory hyperplasia of the thyroid of guinea-pigs by administration of iodine. Arch Pathol. 1926;2:829.

    CAS  Google Scholar 

Download references

Acknowledgment

Dr. Wiseman is a Michael Smith Foundation for Health Research (MSFHR) Scholar, and his work was supported by the MSFHR. Dr. Griffith was supported by the MSFHR and the Canadian Institutes of Health Research (CIHR).

Author information

Authors and Affiliations

  1. Department of Surgery, St. Paul’s Hospital & The University of British Columbia, Vancouver, BC, Canada

    Amanda Johner MD, Leanne Wood MD, Hannah Piper MD, FRCSC & Sam M. Wiseman MD, FRCSC

  2. Department of Medical Genetics, University of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada

    Obi L. Griffith PhD & Steven J. M. Jones PhD

  3. Michael Smith Genome Sciences Center, Vancouver, BC, Canada

    Obi L. Griffith PhD & Steven J. M. Jones PhD

  4. Department of Endocrinology, St. Paul’s Hospital & The University of British, Columbia, Vancouver, BC, Canada

    Graeme Wilkins MD, FRCPC

  5. Department of Pathology & Laboratory Medicine, St. Paul’s Hospital & The University of British Columbia, Vancouver, BC, Canada

    Blair Walker MD, FRCPC

  6. Department of Surgery, Kelowna General Hospital, Kelowna, BC, Canada

    Christopher Baliski MD, FRCSC

Authors
  1. Amanda Johner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Obi L. Griffith PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Blair Walker MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leanne Wood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hannah Piper MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Graeme Wilkins MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christopher Baliski MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven J. M. Jones PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sam M. Wiseman MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sam M. Wiseman MD, FRCSC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johner, A., Griffith, O.L., Walker, B. et al. Detection and Management of Hypothyroidism Following Thyroid Lobectomy: Evaluation of a Clinical Algorithm. Ann Surg Oncol 18, 2548–2554 (2011). https://doi.org/10.1245/s10434-011-1627-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1627-1

Keywords

Search

Navigation