Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis
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META-ANALYSIS
Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis Zhe Li
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Yuxuan Qiu1 Yuan Fei1 Zhichao Xing1 Jingqiang Zhu1 Anping Su1 ●
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Received: 11 April 2020 / Accepted: 27 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This systematic review and meta-analysis evaluated the prevalence of and risk factors for hypothyroidism following hemithyroidectomy as new evidence obtained in recent years warranted an update of previous meta-analyses. Methods The PubMed, Embase, and Cochrane Library databases were searched through November 1, 2019, for articles examining the hypothyroidism prevalence and risk factors after lobectomy. The prevalence rate, risk ratio (RR), weighted mean difference (WMD) and standardized mean difference (SMD) were assessed by conducting a meta-analysis of proportions, binary variables, and continuous variables, respectively, using random-effects models. Results Fifty-one studies showed a pooled risk of 29.9% (95% confidence interval (CI), 24.6–35.2%) for hypothyroidism following hemithyroidectomy. Risk factors for the development of postoperative hypothyroidism included the female sex (RR, 1.169; 95% CI, 1.040–1.314; P = 0.009), a higher preoperative thyrotropin (TSH) level (RR, 2.955; 95% CI, 2.399–3.640; P = 0.000), a lower preoperative FT4 level (SMD, −0.818; 95% CI, −1.623–−0.013; P = 0.047), concomitant lymphocyte infiltration (RR, 1.558; 95% CI, 1.203–2.018; P = 0.001), Hashimoto’s thyroiditis (HT) (RR, 1.480; 95% CI, 1.192–1.838; P = 0.000), a lighter weight of the remaining gland (WMD, −2.740; 95% CI, −3.708–−1.772; P = 0.000), and a right side lobectomy (RR, 1.404; 95% CI, 1.075–1.835; P = 0.013). Conclusions Hypothyroidism is a significant complication after lobectomy, and appropriate and personalized surgical strategies should be designed after a careful preoperative assessment based on the estimated risk of hypothyroidism and risk factors. Keywords Hypothyroidism Hemithyroidectomy Prevalence Risk factor Meta-analysis ●
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Introduction Hemithyroidectomy has been increasingly applied in patients with numerous thyroid diseases, such as unilateral goiter, single toxic adenoma and low-risk papillary thyroid carcinoma [1]. The postoperative incidences of hypoparathyroidism, hypothyroidism and recurrent laryngeal nerve paralysis are significantly lower for patients who have undergone lobectomy than patients who underwent total
These authors contributed equally: Zhe Li, Yuxuan Qiu Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02410-5) contains supplementary material, which is available to authorized users. * Anping Su [email protected] 1
Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, PR China
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thyroidectomy [2–4]. However, a recurrence of contralateral nodules may necessitate a second operation [5]. Theoretically, one thyroid
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