Publication:

Hypothyroidism following hemithyroidectomy: a study in a tertiary care hospital, Chittagong, Bangladesh

Background Hypothyroidism results from insufficient production and secretion of thyroid hormones. This may be due to disturbance within the thyroid gland itself (primary hypothyroidism) or within the hypothalamic-pituitary-thyroid axis (secondary hypothyroidism). The objective of this study is to determine the incidence, risk factors and management of hypothyroidism occurring after hemithyroidectomy for benign non-toxic thyroid disease.

Methods We conducted a prospective cross sectional study of 50 euthyroid patients with benign non-toxic thyroid disease who had undergone hemithyroidectomy from January 2012 to December 2012 admitted in the department of otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. All patients were evaluated for age, sex, pre-operative and post-operative TSH levels, histopathology and follow up. Time of diagnosis and therapeutic dose of thyroid hormone were determined for patients with hypothyroidism.

Results As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies.

Conclusions Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.