Thyroid hormone replacement therapy, surveillance ultrasonography, and fine-needle aspiration after hemithyroidectomy.
OBJECTIVE
We undertook a retrospective analysis of a single surgeon's experience at a tertiary care teaching hospital to determine the rates of surveillance ultrasound, fine-needle aspiration (FNA), and the need for thyroid hormone replacement therapy (THRT) after hemithyroidectomy.


METHODS
The study population comprised 120 consecutive patients who underwent hemithyroidectomy by one surgeon from January 2008 to June 2011. The medical records were reviewed for preoperative and postoperative calcium levels, fiberoptic direct laryngoscopy examination of vocal fold mobility, postoperative complications, final pathology, and postoperative follow-up.


RESULTS
Fifteen patients required completion thyroidectomy for malignancy and were excluded from the surveillance analysis. Of the remaining 105 patients, 10 (9.5%) required postoperative THRT. The likelihood for THRT was significantly associated with increased age (p = 0.01) and the presence of thyroiditis (p = 0.04). Other factors, such as gender, body mass index, residual thyroid volume, and presence of contralateral lobe nodules, were not significantly associated with this likelihood (p > 0.05). Twenty-three patients (21.9%) were followed with surveillance ultrasound, of whom 12 (11.4%) underwent FNA for nodule(s) in the contralateral lobe. Seventy-eight percent of patients did not require any long-term postoperative surveillance. There were no instances of permanent recurrent laryngeal nerve injury or hypoparathyroidism.


CONCLUSIONS
Hemithyroidectomy is an effective and efficient option for the management of benign and suspicious thyroid nodules. However, patients of increased age and/or with thyroiditis are at higher risk for postoperative hypothyroidism, and should be counseled to consider total thyroidectomy to avoid the need for long-term surveillance and the possible need for a second operation.
Department of Surgery, Division of Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
Salem I
SI
Noureldine
Amna
A
Khan
Saleh A
SA
Massasati
William
W
Kethman
Emad
E
Kandil
D000328:Adult; D000368:Aged; D000465:Algorithms; D044963:Biopsy, Fine-Needle; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D007037:Hypothyroidism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013963:Thyroid Hormones / Q000627:therapeutic use*; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
D013963:Thyroid Hormones