Hypothyroidism following partial thyroidectomy for thyrotoxicosis and its relationship to thyroid remnant size

Abstract

One hundred and twenty-two patients were reviewed 1-7 years after partial thyroidectomy for thyrotoxicosis by two surgeons who had left thyroid remnants of different size. There was no significant difference in the prevalence of hypothyroidism or in the serum levels of thyroxine, tri-iodothyronine or thyroid-stimulating hormone between the two groups of patients. The overall prevalence of hypothyroidism was 16 per cent.

Results of Surgery for Toxic Multinodular Goiter

“…Therefore, subtotal thyroidectomy has no advantage over total thyroidectomy, as it still results in the need for thyroxine supplementation. 24 We recommend total thyroidectomy for the treatment of TMG. Mittendorf and McHenry 3 also suggest the Dunhill technique as a good alternative.…”

“…Thus, the lower the rate of relapse, the higher the rate of hyperthyroidism. 6,[22][23][24] According to Mittendorf and McHenry, 3 subtotal thyroidectomy is not appropriate for treating TMG because if the remnant is large, hyperthyroidism can result, necessitating more treatment or even surgical intervention with its consequent risk, whereas if the remnant is small, hypothyroidism will persist. Therefore, subtotal thyroidectomy has no advantage over total thyroidectomy, as it still results in the need for thyroxine supplementation.…”

Serum thyroglobulin and its autoantibody following subtotal thyroid resection of Graves' disease

“…Conversely, the development of hypothyroidism after operative treatment has been the object of much interest [4,7,29]. The current view is that the size of the thyroid remnant is of major importance in the development of post-operative myxoedema [7,30], although in one large series no such relation could be demonstrated [31]. The next point of importance is possibly the presence of a concomitant autoimmune thyroiditis [26].…”

Invited commentary

“…Although there is a range of a few grams in the preservation of thyroid tissue which does not influence the incidence of postoperative hypothyroidism in the surgical treatment of Graves' disease, the size of the remnant is important [6,7]. Thus, Crile and McCullagh pointed out a number of years ago the inverse ratio between recurrent or persistent hyperthyroidism and hypothyroidism in relation to the size of the preserved remnant [8].…”