Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre.
BACKGROUND
Auto-immune thyroiditis, associated with detectable thyroid auto-antibodies (TAAs) and lymphocytic infiltration into the gland, is known to be associated with progressive development of hypothyroidism. This study examines those patients who required surgical treatment of non-toxic nodular goitre by hemithyroidectomy to determine whether the presence of TAAs in the circulation and/or lymphocytic infiltration of the gland resulted in a significant degree of post-operative hypothyroidism.


METHODS
This was a prospective study, with data collected retrospectively. All patients operated on for thyroid disease in the unit over a 5-year period were documented, and those patients treated by hemithyroidectomy for non-toxic nodular goitre formed the study group. TAAs were measured, histology re-examined and patients followed up for at least 2 years to detect clinical or sub-clinical hypothyroidism.


RESULTS
Of the 158 patients who comprised the study group, 38 (24.1%) developed hypothyroidism. Forty-one (25.9%) had circulating levels of TAAs, 31 of these (75.6%) having high levels. Of these 41 patients, 22 (53.7%) became hypothyroid. Twenty (64.5%) of the 31 patients with high levels of TAAs required post-operative thyroxine. Of the remaining 117 patients with no detectable TAAs, only 16 (13.7%) became hypothyroid.


CONCLUSIONS
All patients requiring treatment by hemithyroidectomy should have circulating TAA measurements carried out pre-operatively. If positive, they should be followed up indefinitely because of the strong possibility (P < 0.001) of the development of hypothyroidism.
Buchanan
M A
MA
Department of Surgery, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, U.K.
Lee
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000378:metabolism; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology* / Q000517:prevention & control; D008214:Lymphocytes / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D013965:Thyroidectomy / Q000009:adverse effects*
D001323:Autoantibodies