|Year : 2015 | Volume
| Issue : 3 | Page : 107-109
Hypothyroidism after hemithyroidectomy for colloid goiter: Is it a reality
Karan Gupta, Naresh K Panda, Prachi Jain, Jaimanti Bakshi, Roshan Verma
Department of Otolaryngology and Head-Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||16-Oct-2015|
Dr. Karan Gupta
Department of Otolaryngology and Head-Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
Objective: The objective was to determine the overall risk of hypothyroidism (clinical and subclinical) after hemithyroidectomy for colloid goiter. Materials and Methods: Prospective review of 54 patients who underwent hemithyroidectomy for colloid goiter at a tertiary care center from January, 2010 to December, 2012 with regular follow-up. Results: A total of 54 patients were included in the study with 38 females and 16 males (M:F = 1:3). Mean age was 38 years (range: 23-59 years). All underwent hemithyroidectomy for preoperative diagnosis of colloid goiter, which was confirmed on postoperative histopathological examination. Patients were kept on regular follow-up with repeat thyroid function tests after every 6 months. Mean follow-up was 30.7 months. Subclinical hypothyroidism was found in 8 patients (14.8% prevalence) at a mean follow-up of 16.7 months postsurgery. T3 and T4 levels were within normal limits in all patients with no clinical hypothyroidism detected. No patient was on thyroid hormone supplementation. Conclusion: Our study shows a 14.8% prevalence of subclinical hypothyroidism following hemithyroidectomy for colloid goiter. Patients with subclinical hypothyroidism are at an increased risk of developing clinical hypothyroidism. The risk of hypothyroidism after hemithyroidectomy is an important element in decision making for individual patient and health care provider.
Keywords: Colloid goiter, hemithyroidectomy, hypothyroidism
|How to cite this article:|
Gupta K, Panda NK, Jain P, Bakshi J, Verma R. Hypothyroidism after hemithyroidectomy for colloid goiter: Is it a reality. Thyroid Res Pract 2015;12:107-9
|How to cite this URL:|
Gupta K, Panda NK, Jain P, Bakshi J, Verma R. Hypothyroidism after hemithyroidectomy for colloid goiter: Is it a reality. Thyroid Res Pract [serial online] 2015 [cited 2020 Feb 18];12:107-9. Available from: http://www.thetrp.net/text.asp?2015/12/3/107/159527
| Introduction|| |
Hemithyroidectomy is a frequently performed surgical operation. Indications for hemithyroidectomy include symptomatic unilateral goiter or toxic adenoma. Usually, its aim wass to exclude malignancy in patients with solitary thyroid nodules with suspicious or indeterminate characteristics at fine-needle aspiration cytology.  The majority of nodules are found to be histologically benign. , The price that is paid for the additional certainty provided by surgery is not negligible; postoperative bleeding, laryngeal nerve injury, wound infection, and hypothyroidism are well-known side effects of hemithyroidectomy. 
Hypothyroidism can be accompanied by a range of clinical manifestations, negatively impacting health status.  Apart from the need for regular doctor visits and blood check-ups, long-term thyroid hormone therapy may be associated with accelerated loss of bone mineral density, atrial fibrillation, changes in left ventricular function, and impairment in psychological well-being. ,,,, The reported risk of hypothyroidism after hemithyroidectomy varies greatly in the literature.
The aim of the present study was to determine the overall risk of hypothyroidism after hemithyroidectomy for benign colloid goiter in preoperatively euthyroid patients, as well as the risk of clinically relevant hypothyroidism.
| Materials and Methods|| |
After getting the ethical clearance from the Institutional Ethics Board, 54 patients (38 females and 16 males) with preoperative diagnosis of colloid goiter who underwent hemithyroidectomy at a tertiary care center from January, 2010 to December, 2012 were included in the study. The diagnosis of colloid goiter was confirmed on histopathology postoperatively.
Before taking up the patients for surgery, every patient underwent a preoperative ultrasound (USG) neck, fine needle aspiration cytology (FNAC) of the nodule in the thyroid and a baseline thyroid function test (TFTs) (T3, T4 and thyroid stimulating hormone [TSH]). Patients with no evidence of features of malignancy on USG neck with FNAC suggestive of benign colloid goiter who were euthyroid were only included in the study. Patients were kept on regular follow-up and along with a complete clinical examination; TFTs (T3, T4, and TSH) were done first after 1-month of the surgery and then every 6 months and recorded. The normal range of serum T3 (S. T3) was 0.9-2.7 nmol/L; S. T4 was 4-12.3 μg/dL; and S. TSH was 0.3-5.0 μIU/mL.
| Results|| |
A total of 54 patients (38 females and 16 males, F:M = 3:1) of benign colloid goiter who underwent hemithyroidectomy were included in the study. The diagnosis was confirmed on histopathology postoperatively. The mean age of patients was 38 years (range: 23-59 years). The patients were kept on regular follow-up with a mean follow-up of 30.7 months (range from 42 to 24 months). The TFTs were initially repeated 1-month after the surgery and then was done every 6 months. Of the 54 patients included in the study, 8 patients (14.8%) developed sub-clinical hypothyroidism with S. TSH value above 5.0 μIU/mL, usually seen at a mean follow-up of 16.7 months after surgery [Figure 1]. None of the patients developed clinical hypothyroidism till the end of the study, with normal S. T3 and S. T4 in all patients.
|Figure 1: Line chart of the highest value of serum thyroid stimulating hormone attained for the patients during the follow-up after hemithyroidectomy|
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None of the patients developed any overt signs of hypothyroidism on clinical examination.
Of the 8 patients who developed sub-clinical hypothyroidism after hemithyroidectomy for colloid goiter, 5 (62.5%) patients had a preoperative S. TSH value above 1 μIU/mL.
| Discussion|| |
The risk of hypothyroidism following hemithyroidectomy in the present study was 14.8%, with the risk of hypothyroidism in the literature ranges from 0% to 43%. ,,,, A meta-analysis from Verloop et al. puts the risk of hypothyroidism after hemithyroidectomy at 21%.  However, the problem with most of these studies is that they have included all thyroid pathologies ranging from benign goiters to malignant nodules in the study. The risk of hypothyroidism might vary between the various pathologies of the thyroid and thus can't be generalized for all cases of hemi-thyroidectomies. 
All the patients in our study developed sub-clinical hypothyroidism (elevated S. TSH >5 μIU/mL with normal S. T3 and S. T4) with no patients developing clinical hypothyroidism on long-term follow-up. Although subclinical hypothyroidism could have beneficial effects in the elderly,  most patients undergoing hemithyroidectomy are under the age of 65 years, and potential adverse consequences of subclinical hypothyroidism in middle-aged populations have been shown. ,,, Furthermore, patients with subclinical hypothyroidism are at increased risk of developing clinical hypothyroidism.  The clinical implications of sub-clinical hypothyroidism in patients who have undergone hemithyroidectomy is still not clear and further work is required to clarify this issue.
The majority of the patients develop hypothyroidism within first 6-12 months of the surgery,  but few might even develop hypothyroidism after 18-24 months after the surgery as seen in our study. Hence, a long-term follow-up is required in these patients to detect hypothyroidism after hemithyroidectomy and to manage the same.
In the literature concomitant thyroiditis in the excised thyroid lobe, preoperative TSH levels in the higher-normal range, and positive anti-thyroid peroxidase antibody levels are risk factors for the development of hypothyroidism after hemithyroidectomy.  The most significant predictor is the preoperative TSH level, with an approximate doubling of risk for each 1 unit of TSH increase over 1 μIU/ml.  In our study, 62.5% of the patients who developed hypothyroidism had preoperative S. TSH >1 μIU/mL.
| Conclusion|| |
Our study shows a 14.8% prevalence of subclinical hypothyroidism following hemithyroidectomy for colloid goiter. Many potential adverse consequences of subclinical hypothyroidism can be seen in the middle-aged population. Furthermore, patients with subclinical hypothyroidism are at an increased risk of developing clinical hypothyroidism. The risk of hypothyroidism after hemithyroidectomy is an important element in decision making for individual patient and health care provider.
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