Levothyroxine Supplementation Following Hemithyroidectomy: Incidence, Risk Factors, and Characteristics

  • Dongbin AhnEmail author
  • Gil Joon Lee
  • Jin Ho Sohn
Endocrine Tumors



The goal of the present study was to determine the actual incidence, predictive risk factors, and clinical characteristics of levothyroxine supplementation (LT4S) used for the management of hypothyroidism after hemithyroidectomy.


From 2008 to 2015, we included 535 patients who underwent hemithyroidectomy. LT4S was initiated based on three major criteria: the development of overt hypothyroidism, subclinical hypothyroidism with thyroid-stimulating hormone (TSH) levels > 10 mIU/L, or subclinical hypothyroidism with TSH levels of 4.5–10 mIU/L with associated signs/symptoms.


During the 69-month follow-up period, 321 patients (60%) developed overall hypothyroidism following hemithyroidectomy, and 141 ultimately required LT4S, with an overall LT4S incidence of 26.4%. The most common cause of LT4S initiation was subclinical hypothyroidism with TSH levels > 10 mIU/L. In 141 patients with LT4S, the mean maintenance dose of levothyroxine was 1.34 μg/kg, and only 6 patients (4.3%) discontinued LT4S during the follow-up. The 1-, 3-, 5-, and 7-year LT4S-free survival rates of 535 patients were 88.6%, 80.2%, 73.8%, and 69.1%, respectively. Preoperative TSH levels > 2.12 mIU/L and coexistence of Hashimoto’s thyroiditis were significantly associated with LT4S following hemithyroidectomy. The risk of LT4S increased by 1.401 times, as preoperative TSH levels increased by 1 mIU/L.


A quarter of patients required LT4S after hemithyroidectomy for the management of hypothyroidism, with a mean maintenance levothyroxine dose of 1.34 μg/kg. The preoperative TSH level and coexistence of Hashimoto’s thyroiditis were significant predictive factors of LT4S following hemithyroidectomy.




Supplementary material

10434_2019_7786_MOESM1_ESM.tif (39 kb)
Supplementary material 1 (TIFF 38 kb)


  1. 1.
    Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.CrossRefGoogle Scholar
  2. 2.
    Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014;81(Suppl 1):1–122.CrossRefGoogle Scholar
  3. 3.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)Thyroid Carcinoma v. 2. National Comprehensive Cancer Network. 2018.Google Scholar
  4. 4.
    Su SY, Grodski S, Serpell JW. Hypothyroidism following hemithyroidectomy: a retrospective review. Ann Surg. 2009;250(6):991–4.CrossRefGoogle Scholar
  5. 5.
    Verloop H, Louwerens M, Schoones JW, Kievit J, Smit JW, Dekkers OM. Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies. J Clin Endocrinol Metab. 2012;97(7):2243–55.CrossRefGoogle Scholar
  6. 6.
    Said M, Chiu V, Haigh PI. Hypothyroidism after hemithyroidectomy. World J Surg. 2013;37(12):2839–44.CrossRefGoogle Scholar
  7. 7.
    Ahn D, Sohn JH, Jeon JH. Hypothyroidism following hemithyroidectomy: incidence, risk factors, and clinical characteristics. J Clin Endocrinol Metab. 2016;101(4):1429–36.CrossRefGoogle Scholar
  8. 8.
    Park S, Jeon MJ, Song E, et al. Clinical features of early and late postoperative hypothyroidism after lobectomy. J Clin Endocrinol Metab. 2017;102(4):1317–24.CrossRefGoogle Scholar
  9. 9.
    Stoll SJ, Pitt SC, Liu J, Schaefer S, Sippel RS, Chen H. Thyroid hormone replacement after thyroid lobectomy. Surgery. 2009;146(4):554–8 (discussion 558-60).Google Scholar
  10. 10.
    Lee DY, Seok J, Jeong WJ, Ahn SH. Prediction of thyroid hormone supplementation after thyroid lobectomy. J Surg Res. 2015;193(1):273–8.CrossRefGoogle Scholar
  11. 11.
    Ng P, Ho C, Tan WB, et al. Predictors of thyroxine replacement following hemithyroidectomy in a south east Asian cohort. Head Neck. 2018;41(5):1463–7.CrossRefGoogle Scholar
  12. 12.
    Turner MR, Camacho X, Fischer HD, et al. Levothyroxine dose and risk of fractures in older adults: nested case-control study. BMJ. 2011;342:d2238.CrossRefGoogle Scholar
  13. 13.
    Freudenthal B, Williams GR. Thyroid-stimulating hormone suppression in the long-term follow-up of differentiated thyroid cancer. Clin Oncol (R Coll Radiol). 2017;29(5):325–8.CrossRefGoogle Scholar
  14. 14.
    Shin DW, Suh B, Lim H, Yun JM, Song SO, Park Y. J-shaped association between postoperative levothyroxine dosage and fracture risk in thyroid cancer patients: a retrospective cohort study. J Bone Miner Res. 2018;33(6):1037–43.CrossRefGoogle Scholar
  15. 15.
    Cox C, Bosley M, Southerland LB, et al. Lobectomy for treatment of differentiated thyroid cancer: can patients avoid postoperative thyroid hormone supplementation and be compliant with the American Thyroid Association guidelines? Surgery. 2018;163(1):75–80.CrossRefGoogle Scholar
  16. 16.
    Col NF, Surks MI, Daniels GH. Subclinical thyroid disease: clinical applications. JAMA. 2004;291(2):239–43.CrossRefGoogle Scholar
  17. 17.
    Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291(2):228–38.CrossRefGoogle Scholar
  18. 18.
    Jin J, Allemang MT, McHenry CR. Levothyroxine replacement dosage determination after thyroidectomy. Am J Surg. 2013;205(3):360–3 (discussion 363-4).Google Scholar
  19. 19.
    Ha TK, Kim DW, Park HK, et al. The effect of levothyroxine discontinuation timing on postoperative hypothyroidism after hemithyroidectomy for papillary thyroid microcarcinoma. Int J Endocrinol. 2016;2016:3240727.CrossRefGoogle Scholar
  20. 20.
    Cooper DS, Specker B, Ho M, et al. Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid. 1998;8(9):737–44.CrossRefGoogle Scholar
  21. 21.
    Brabant G. Thyrotropin suppressive therapy in thyroid carcinoma: what are the targets? J Clin Endocrinol Metab. 2008;93(4):1167–9.CrossRefGoogle Scholar
  22. 22.
    Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–81 (discussion 381-4).Google Scholar
  23. 23.
    Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD. Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck. 2011;33(5):645–9.CrossRefGoogle Scholar
  24. 24.
    Li X, Zhao C, Hu D, et al. Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma. Oncol Lett. 2013;5(4):1412–6.CrossRefGoogle Scholar
  25. 25.
    Park YM, Lee DY, Oh KH, et al. Clinical implications of pathologic factors after thyroid lobectomy in patients with papillary thyroid carcinoma. Oral Oncol. 2017;75:1–5.CrossRefGoogle Scholar
  26. 26.
    Son HJ, Kim JK, Jung YD, et al. Comparison of outcomes between hemithyroidectomy alone and hemithyroidectomy with elective unilateral central neck dissection in patients with papillary thyroid microcarcinoma. Head Neck. 2018;40(11):2449–54.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology-Head and Neck Surgery, School of MedicineKyungpook National UniversityDaeguKorea

Personalised recommendations