title: Hemithyroidectomy: a meta-analysis of postoperative need for hormone replacement and complications.
abstract: BACKGROUND
  We sought to determine certain factors predicting postoperative need for hormone replacement therapy (HRT) after hemithyroidectomy.
  
  
  METHODS
  A PubMed search was conducted to identify articles with separate cohorts for total and hemithyroidectomy. Outcomes of interest included hypothyroidism and complications.
  
  
  RESULTS
  Of 50,445 patients, 15,412 (30.6%) underwent hemithyroidectomy. The reported incidence rate of postoperative hypothyroidism was 10.9-48.8%. The pooled mean preoperative thyroid-stimulating hormone (TSH) level was 1.06 µIU/l (0.83-1.29) higher in hypothyroid patients. A preoperative TSH level >2.5 µIU/l was associated with a relative risk (RR, 95% CI) of 3.16 (2.03-4.90) for postoperative hypothyroidism. There was a significant pooled RR of 3.52 (2.55-4.86) for thyroid antibodies and 3.30 (2.49-4.36) for thyroiditis on pathology for postoperative HRT. The pooled RR for postoperative complications was 10.67 (5.75-19.31) for temporary hypocalcemia, 3.17 (1.72-5.83) for permanent hypocalcemia, 1.69 (1.30-2.20) for temporary injury to the recurrent laryngeal nerve (RLN), 1.85 (1.28-2.69) for permanent RLN injury and 2.58 (1.69-3.93) for hemorrhage in patients who underwent total thyroidectomy compared to hemithyroidectomy.
  
  
  CONCLUSIONS
  Higher preoperative TSH levels, presence of anti-thyroid antibodies and thyroiditis predict postoperative need for HRT. It is imperative to counsel patients with these findings regarding their higher risk of developing postoperative hypothyroidism and need for HRT after hemithyroidectomy.
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA. ekandil @ tulane.edu
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Barath
authors.initials: B
authors.lastname: Krishnan
authors.forename: Salem I
authors.initials: SI
authors.lastname: Noureldine
authors.forename: Lu
authors.initials: L
authors.lastname: Yao
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D020249:Hormone Replacement Therapy; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D061226:Recurrent Laryngeal Nerve Injuries / Q000453:epidemiology; D012306:Risk; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013966:Thyroiditis / Q000453:epidemiology