Incidence and Risk Factors for Development of Hypothyroidism after Hemithyroidectomy


  • Eiamkulvorapong A


Hypothyroidism, Hemithyroidectomy, Thyroid antibody, Risk factors


Objectives: To evaluate the incidence of hypothyroidism after hemithyroidectomy and possible risk factors to predict postoperative hypothyroidism. Methods: We performed a prospective study of patients with non - toxic thyroid disease undergoing hemithyroidectomy between May 2015 and June 2018 at the Department of Otorhinolaryngology, Samutsakhon hospital. Only preoperative euthyroid patients were included. The preoperative thyroid antibodies and histopathology of thyroid specimens were collected. The thyroid function test was evaluated at two months and six months after surgery. Results: One hundred and six patients were recruited for the present study, twenty patients (18.9%) developed hypothyroidism (6 patients overt or symptomatic hypothyroidism, 14 patients subclinical hypothyroidism) at two months after surgery and nineteen patients (17.9%) developed hypothyroidism (7 patients overt or symptomatic hypothyroidism, 14 patients subclinical hypothyroidism) at six months after surgery. The mean preoperative thyrotropin level was significantly higher in the hypothyroid group than in the euthyroid group (2.3 ± 1.3 vs 0.7 ± 0.5 micro IU / ml), The preoperative high normal thyroid stimulating hormone (TSH) > 2 micro IU / ml) developed hypothyroidism 89.5% in contrast to only 8.1% of those the preoperative TSH ≤ 2 micro IU / ml (odds ratio 97.1). In anti-thyroid microsomal antibody test, the rate of post - operative hypothyroidism among patients with elevated thyroid antibody had statistically significant difference from those with normal thyroid antibody result (p = 0.03). The preoperative high normal TSH (> 2 micro IU /ml), anti-thyroid microsomal antibody and anti-thyroglobulin antibody positive titer showed 100% positive predictive value and 80.4% negative predictive value. Conclusion: The incidence of hypothyroidism after hemithyroidectomy was 18.9% at two months after surgery and 17.9% at six months after surgery. The preoperative high normal TSH > 2 micro IU /ml, elevated thyroid antibodies indicated thyroiditis were good pre-operative predictive markers. Such high risk patients needed close follow up TSH monitoring before the onset of clinical hypothyroidism.


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.

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.

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.

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

Griffiths NJ, Murley RS, Gulin R, Simpson RD, Woods TF, Burnett D. Thyroid function following partial thyroidectomy. Br j Surg 1974; 61:626-32.

McHenry CR, Slusarczyk SJ. Hypothyroidism following hemithyroidectomy : incidence, risk factors and management. Surgery 2000; 128:994-8.

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

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.

Tomoda C, Ito Y, Kbayashi K, Miya A, Miyauchi A. Subclinical hypothyroism following hemithyroidectomy:a simple risk-scoring system using age and preoperative thyrotropin level.ORL J Otorhinolaryngol Relat Spec 2011; 73:68-71.

Su SY, Grodski S, Serpell JW. Hypothyroidism following hemithyroidectomy : a retrospective review.Ann Surg 2009; 250:991-4.

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.

Cho JS, Shin SH, Song YJ, Kim HK, Park MH, Yoon JH, et al. Is it possible to predict hypothyroidism after thyroid lobectomy through thyrotropin,thyroglobulin,antithyroglobulin and anti-microsomal antibody? J Korean Surg Soc 2011; 81:380-6.

Amino N, Hagen SR, Yamada N, Refetoff S. Measurement of circulating thyroid microsomal antibodies by the tanned red cell haemagglutination technique: its usefulness in the diagnosis of autoimmiune thyroid diseases.Clin Endocrinol (Oxf) 1976; 5:115-25.

Chotigavanich C, Sureepong P, Ongard S, Eiamkulvorapong A, Boonyaarunnate T, Chongkolwatana C, et al. Hypothyroidism after Hemithyroidectomy : The Incidence and Risk Factors. J Med Assoc Thai 2016; 99:77-83.




How to Cite

Eiamkulvorapong A. Incidence and Risk Factors for Development of Hypothyroidism after Hemithyroidectomy. J DMS [Internet]. 2019 Feb. 1 [cited 2024 Apr. 17];44(1):108-12. Available from:



Original Article