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Risk of Hypothyroidism following Hemithyroidectomy: Systematic Review and Meta-Analysis of Prognostic Studies
Open accessAbstract
CONTEXT: The reported risk of hypothyroidism after hemithyroidectomy shows considerable heterogeneity in literature. OBJECTIVE: The aim of this systematic review and meta-analysis was to determine the overall risk of hypothyroidism, both clinical and subclinical, after hemithyroidectomy. Furthermore, we aimed to identify risk factors for postoperative hypothyroidism. DATA SOURCES: A systematic literature search was performed using several databases, including PubMed. STUDY SELECTION: Original articles in which an incidence or prevalence of hypothyroidism after primary hemithyroidectomy could be extracted were included. DATA EXTRACTION: Study identification and data extraction were performed independently by two reviewers. In case of disagreement, a third reviewer was consulted. DATA SYNTHESIS: A total of 32 studies were included in this meta-analysis. Meta-analysis was performed using logistic regression with random effect at study level. The overall risk of hypothyroidism after hemithyroidectomy was 22% (95% confidence interval, 19-27). A clear distinction between clinical (supranormal TSH levels and subnormal thyroid hormone levels) and subclinical (supranormal TSH levels and thyroid hormone levels within the normal range) hypothyroidism was provided in four studies. These studies reported on an estimated risk of 12% for subclinical hypothyroidism and 4% for clinical hypothyroidism. Positive anti-thyroid peroxidase status is a relevant preoperative indicator of hypothyroidism after surgery. Effect estimates did not differ substantially between studies with lower risk of bias and studies with higher risk of bias. CONCLUSIONS: This meta-analysis showed that approximately one in five patients will develop hypothyroidism after hemithyroidectomy, with clinical hypothyroidism in one of 25 operated patients.
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“The prevalence of hypothyroidism varies from 2% to 3% following lobectomy for TA, although rates of hypothyroidism after lobectomy for nontoxic nodules have been reported to be as high as 20% (254-256), and lower after isthmusectomy in the unique circumstance in which the TA is confined to the thyroid isthmus.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [256]
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“Patients with positive antithyroid antibodies preoperatively have a higher risk of postoperative hypothyroidism (256,278).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [256]
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Metadata
- Authors
- Verloop, H., Louwerens, M., Schoones, J. W., Kievit, J., Smit, J. W. A., & Dekkers, O. M.
- Affiliations
- Leiden University Medical Center (NL)
- Corresponding author
- Dekkers, Olaf M.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-07
- Volume
- 97
- Issue
- 7
- Pages
- 2243-2255
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2061342741
- Cited by
- 220
- References
- 80
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 19 · 2023: 19 · 2022: 28 · 2021: 19 · 2020: 22 · 2019: 15 · 2018: 17 · 2017: 15 · 2016: 13 · 2015: 7 · 2014: 8 · 2013: 5
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Universiteit Leiden
- Leids Universitair Medisch Centrum
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- hemithyroidectomy, postoperative hypothyroidism, subclinical hypothyroidism, overt hypothyroidism, thyroid peroxidase antibodies, thyroid-stimulating hormone, risk factors, thyroidectomy outcomes
- MeSH terms
- Algorithms, Humans, Hypothyroidism, Postoperative Complications, Prognosis, Risk Factors, Thyroidectomy, Incidence
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