Posthemithyroidectomy Hypothyroidism: Updated Meta-Analysis of Risk Factors and Rates of Remission

Konstantinos Apostolou; Ivan Paunovic; Maximos Frountzas; Vladan Zivaljevic; Katarina Tausanovic; Michael Karanikas; Ioannis Koutelidakis; Dimitrios Schizas

doi:10.1016/j.jss.2023.08.020

Posthemithyroidectomy Hypothyroidism: Updated Meta-Analysis of Risk Factors and Rates of Remission

J Surg Res. 2024 Jan:293:102-120. doi: 10.1016/j.jss.2023.08.020. Epub 2023 Sep 19.

Authors

Konstantinos Apostolou¹, Ivan Paunovic², Maximos Frountzas³, Vladan Zivaljevic², Katarina Tausanovic², Michael Karanikas⁴, Ioannis Koutelidakis⁵, Dimitrios Schizas⁶

Affiliations

¹ First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece. Electronic address: konstantinos.apostolou@gmail.com.
² Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ 1st Department of Propaedeutic Surgery, Medical School University of Athens, "Hippocratio" General Hospital, Athens, Greece.
⁴ 1st University Surgical Department, University Hospital of Alexandropoulis, Democritus University of Thrace, Alexandroupolis, Greece.
⁵ Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.
⁶ First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.

PMID: 37734294
DOI: 10.1016/j.jss.2023.08.020

Abstract

Introduction: The aim of this study was to determine the incidence and risk factors for hypothyroidism, both clinical and subclinical, following hemithyroidectomy in preoperatively euthyroid patients, as well as hypothyroidism remission and its time of remission.

Materials and methods: A search was performed in Medline (via PubMed), Web of Science, and the Cochrane Library using the keywords "hemithyroidectomy + postoperative + hypothyroidism" and "hemithyroidectomy + hormone supplementation".

Results: Fifty-four studies with a total of 9,999 patients were included. After a mean follow-up interval of 48.2 mo, the pooled hypothyroidism rate was 29%. The subclinical hypothyroidism rate was 79% of patients with hypothyroidism (18 studies). Moreover, a meta-analysis of 12 studies indicated a pooled hypothyroidism remission rate after hemithyroidectomy of 42% (95% CI: 24%-60%). Older patient age (MD = -2.54, 95% CI = -3.99, -1.10, P = 0.0006), female gender (OR = 0.69, 95% CI = 0.58, 0.82, P < 0.0001), higher preoperative thyroid-stimulating hormone levels (MD = -0,81, 95% CI = -0.96, -0.66, P < 0.00001), pathological preoperative anti-thyroid peroxidase antibodies (OR = 0.37, 95% CI = 0.24, 0.57, P < 0.00001) and anti-thyroglobulin antibodies (OR = 0.52, 95% CI = 0.36, 0.75, P = 00,005), and right-sided hemithyroidectomy (OR = 0.54, 95% CI = 0.43, 0.68, P < 0.00001) were associated with postoperative hypothyroidism development. In metaregression analysis, Asia presented a significantly higher hypothyroidism rate after hemithyroidectomy (34.6%, 95% CI = 29.3%-9.9%), compared to Europe (22.9%, 95% CI = 16.2%-29.5%, P = 0.037) and Canada (1.8%, 95% CI = -22.6%-26.2%, P = 0.013).

Conclusions: Hypothyroidism is a frequent and significant postoperative sequela of hemithyroidectomy, necessitating individualization of treatment strategy based on the underlying disease as well as the estimated risk of hypothyroidism and its risk factors.

Keywords: Hemithyroidectomy; Hypothyroidism; Lobectomy; Remission; Risk; Subclinical.

Publication types

Meta-Analysis

MeSH terms

Female
Humans
Hypothyroidism* / epidemiology
Hypothyroidism* / etiology
Incidence
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Thyroidectomy / adverse effects
Thyrotropin

Substances

Thyrotropin