Annals of Surgical Oncology

, Volume 18, Issue 9, pp 2548–2554 | Cite as

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

  • Amanda Johner
  • Obi L. Griffith
  • Blair Walker
  • Leanne Wood
  • Hannah Piper
  • Graeme Wilkins
  • Christopher Baliski
  • Steven J. M. Jones
  • Sam M. WisemanEmail author
Endocrine Tumors



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.


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.


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).


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.


Hypothyroidism Thyroid Nodule Lymphocytic Infiltration Thyroid Lobe Thyroid Lobectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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).


  1. 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.CrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med. 1998;128:386–94.PubMedGoogle Scholar
  8. 8.
    Biondi B, Filletti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab. 2005;1:32–40.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Su SY, Grodski S, Serpell JW. Hypothyroidism following hemithyroidectomy. Ann Surg. 2009;250:991–4.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Seiberling KA, Dutra JC, Bajaramovic S. Hypothyroidism following hemithyroidectomy for benign nontoxic thyroid disease. Ear Nose Throat J. 2007;86:295–9.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 17.
    Cheung P, Boey J, Wong J. Thyroid function after hemithyroidectomy for benign nodules. World J Surg. 1986;10:718–23.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Schlote B, Nowotny B, Schaaf L. Subclinical hyperthyroidism: physical and mental state of patients. Eur Arch Psychiatry Clin Neurosci. 1992;241:357–64.PubMedCrossRefGoogle Scholar
  20. 20.
    Al-Abadi AC. Subclinical thyrotoxicosis. Postgrad Med J. 2001;77:29–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Burmeister LA, Flores A. Subclinical thyrotoxicosis and the heart. Thyroid. 2002;12:495–9.PubMedCrossRefGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 23.
    McHenry CR, Slusarczyk SJ. Hypothyroidism following hemi-thyroidectomy: Incidence, risk factors and management. Surgery. 2000;128:994–8.PubMedCrossRefGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 25.
    Stoll SJ, Pitt SC, Liu J, Schaefer S, Sippel RS, Chen H. Thyroid hormone replacement after thyroid lobectomy. Surgery. 2009;146:554–8.PubMedCrossRefGoogle Scholar
  26. 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.Google Scholar
  27. 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.Google Scholar
  28. 28.
    Clark OH, Lambert WR, Cavalieri RR, Rapoport B, Hammond ME, Ingbar SH. Compensatory thyroid hypertrophy after hemithyroidectomy in rats. Endrocrinology. 1976;99:988.CrossRefGoogle Scholar
  29. 29.
    Marine D. Control of compensatory hyperplasia of the thyroid of guinea-pigs by administration of iodine. Arch Pathol. 1926;2:829.Google Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Amanda Johner
    • 1
  • Obi L. Griffith
    • 2
    • 3
  • Blair Walker
    • 5
  • Leanne Wood
    • 1
  • Hannah Piper
    • 1
  • Graeme Wilkins
    • 4
  • Christopher Baliski
    • 6
  • Steven J. M. Jones
    • 2
    • 3
  • Sam M. Wiseman
    • 1
    Email author
  1. 1.Department of SurgerySt. Paul’s Hospital & The University of British ColumbiaVancouverCanada
  2. 2.Department of Medical GeneticsUniversity of British Columbia, British Columbia Cancer AgencyVancouverCanada
  3. 3.Michael Smith Genome Sciences CenterVancouverCanada
  4. 4.Department of EndocrinologySt. Paul’s Hospital & The University of British, ColumbiaVancouverCanada
  5. 5.Department of Pathology & Laboratory MedicineSt. Paul’s Hospital & The University of British ColumbiaVancouverCanada
  6. 6.Department of SurgeryKelowna General HospitalKelownaCanada

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