Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

• Published in: World Journal of Surgery
• Main Authors: Michie, W., Beck, J. Swanson, Pollet, J. E.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 1978
• Subjects: Iceland
• Online Access: http://dx.doi.org/10.1007/bf01561500; http://link.springer.com/content/pdf/10.1007/BF01561500.pdf; http://link.springer.com/article/10.1007/BF01561500/fulltext.html; https://onlinelibrary.wiley.com/doi/pdf/10.1007/BF01561500

Abstract Postoperative hypothyroidism is the most common complication of thyroidectomy for thyrotoxicosis. Its incidence is inversely related to remnant size. Destructive autoimmunity, as measured by the presence of antithyroid antibodies in the serum, may be another of the factors predisposing to postoperative hypothyroidism, but the extent to which such considerations should influence remnant size is a matter for debate. Experience in Iceland suggests that high iodine ingestion is associated with a low incidence of hypothyroidism and a high rate of recurrent thyrotoxicosis; consequently, smaller remnants are obligatory in Iceland. Therefore, it would seem that environmental factors also play a part, and that a remnant “norm” for each locality should be determined empirically to achieve optimum balance between hypothyroidism and recurrent thyrotoxicosis. With the establishment of a “norm,” prediction of hypothyroidism for a group of patients is reasonably accurate. For the individual patient, postoperative status cannot be predicted and it is not possible to select for alternative methods of treatment patients who might be at risk of postoperative hypothyroidism. Irrespective of large remnant size, approximately 15% of patients will develop postoperative hypothyroidism. These may be the patients described at the turn of the century, before effective treatment became available, in whom the natural course of the disease progressed through euthyroidism to hypothyroidism. It would appear, for some patients at least, that surgery merely accelerates the natural course of the disease and compresses into a matter of weeks events which normally take several months and even years. Fortunately, postoperative hypothyroidism declares itself within 12–15 months and, if clinical scrutiny is sufficiently acute, late onset hypothyroidism is rare. The ethical responsibility remains for a prolonged follow‐up of all postthyroidectomy patients.