Abstract
Background
After thyroid lobectomy, many patients require ongoing care. This study sought to quantify the rates of surveillance and intervention after thyroid lobectomy.
Methods
One hundred one consecutive patients who underwent a thyroid lobectomy for nodular disease were evaluated. Clinical and follow-up data were obtained by a review of patient charts and included an evaluation of resource utilization related to thyroid disease.
Results
Nineteen patients required completion thyroidectomy for thyroid cancer, and 11 had hypothyroidism before lobectomy. Of the remaining evaluable patients, 30 (42.2%) of 71 required thyroid hormone replacement after lobectomy, with 24 patients having elevated thyroid-stimulating hormone and 6 suppression of nodules in the contralateral lobe. The likelihood of thyroid hormone replacement demonstrated a trend with a contralateral nodule (9 of 14 vs. 21 of 57, P = 0.06) and a significant association with thyroiditis on surgical pathology (10 of 11 vs. 20 of 60, P < 0.001). Of the 82 patients who did not undergo completion lobectomy, 10 (12%) of 82 underwent postoperative fine-needle aspiration of the contralateral lobe, and 25 (30%) of 82 were followed with ultrasound surveillance. Only 27% of patients treated with lobectomy required no further surveillance or intervention. There were no instances of permanent recurrent laryngeal nerve injury.
Conclusions
After thyroid lobectomy, most patients require continued surveillance and intervention. With a near-zero complication rate, total thyroidectomy may be a more effective and efficient option for management of nodular thyroid disease.
Similar content being viewed by others
References
Mittendorf EA, McHenry CR. Thyroidectomy for selected patients with thyrotoxicosis. Arch Otolaryngol Head Neck Surg. 2001;127:61–5.
Spanknebel K, Chabot JA, DiGiorgi M, et al. Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg. 2005;201:375–85.
Vaiman M, Nagibin A, Olevson J. Complications in primary and completed thyroidectomy. Surg Today. 2010;40:114–8.
Barczynski M, Konturek A, Hubalewska-Dydejczyk A, et al. Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg. 2010;34:1203–13.
Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32:1313–24.
Bellantone R, Lombardi CP, Bossola M, et al. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg. 2002;26:1468–71.
Berglund J, Bondesson L, Christensen SB, et al. Indications for thyroxine therapy after surgery for nontoxic benign goitre. Acta Chir Scand. 1990;156:433–8.
Hedman I, Jansson S, Lindberg S. Need for thyroxine in patients lobectomised for benign thyroid disease as assessed by follow-up on average fifteen years after surgery. Acta Chir Scand. 1986;152:481–6.
Stoll SJ, Pitt SC, Liu J, et al. Thyroid hormone replacement after thyroid lobectomy. Surgery. 2009;146:554–8.
Farkas EA, King TA, Bolton JS, Fuhrman GM. A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules. Am Surg. 2002;68:678–82.
Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102.
Spencer CA. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin Proc. 1988;63:1214–22.
De Carlucci D Jr, Tavares MR, Obara MT, et al. Thyroid function after unilateral total lobectomy: risk factors for postoperative hypothyroidism. Arch Otolaryngol Head Neck Surg. 2008;134:1076–9.
Koh YW, Lee SW, Choi EC, et al. Prediction of hypothyroidism after hemithyroidectomy: a biochemical and pathological analysis. Eur Arch Otorhinolaryngol. 2008;265:453–7.
McHenry CR, Slusarczyk SJ. Hypothyroidisim following hemithyroidectomy: incidence, risk factors, and management. Surgery. 2000;128:994–8.
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.
Vaiman M, Nagibin A, Hagag P, et al. Hypothyroidism following partial thyroidectomy. Otolaryngol Head Neck Surg. 2008;138:98–100.
Repplinger D, Bargren A, Zhang YW, et al. Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer? J Surg Res. 2008;150:49–52.
Lubitz CC, Faquin WC, Yang J, et al. Clinical and cytological features predictive of malignancy in thyroid follicular neoplasms. Thyroid. 2010;20:25–31.
Williams MD, Suliburk JW, Staerkel GA, et al. Clinical significance of distinguishing between follicular lesion and follicular neoplasm in thyroid fine-needle aspiration biopsy. Ann Surg Oncol. 2009;16:3146–53.
McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A. Follicular or Hürthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery. 1999;126:798–802.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spanheimer, P.M., Sugg, S.L., Lal, G. et al. Surveillance and Intervention After Thyroid Lobectomy. Ann Surg Oncol 18, 1729–1733 (2011). https://doi.org/10.1245/s10434-010-1544-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-010-1544-8