Management tactics of patients after hemithyroidectomy for benign unilateral euthyroid goiter

Abstract

The purpose of this analysis is to assess, based on the results of world studies, the risk of developing surgical hypothyroidism (both subclinical and manifest), the time of occurrence of hypothyroidism after hemithyroidectomy, and the frequency of relapses in the part of the thyroid gland that remains. Material and methods. PubMed electronic databases were used to search for relevant studies. Results. There 13 studies were selected to analyze the characteristics of surgical hypothyroidism, in 8 of them is quantitative data on the structure of hypothyroidism, which was divided into two subtypes: subclinical and manifest. The review presents data on the most common complication after hemithyroidectomy — hypothyroidism, its structure, frequency of development, time of onset after surgery and factors that affect the development of surgical hypothyroidism. Among the main ones, the preoperative TSH level, the patient’s age,
and the presence of antithyroid antibodies were considered. Also the risks of nodule formation in the left part of the thyroid gland after hemithyroidectomy were described. In general, in the short term, there was no development of nodules in the part that remained. Conclusions. The main complication in the long term after hemithyroidectomy due to unilateral benign euthyroid thyroid disease is hypothyroidism, which develops in 10.9-48.8% of cases. The incidence
of postoperative hypothyroidism and its transition from transient to permanent form depends primarily on preoperative indicators of thyroid-stimulating hormone and levels of antithyroid antibodies. Surgical thyroid hormone replacement therapy should not be prescribed routinely, but only in cases where hypothyroidism changes from subclinical to manifest form (TSH above 10 mOd / ml).