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Abstract：
BACKGROUND: The incidence of hypothyroidism following hemithyroidectomy and risk factors associated with its occurrence are not completely understood. This systematic review investigated the incidence and risk factors for hypothyroidism, thyroxine supplementation following hemithyroidectomy as well as the course of post-operative hypothyroidism, including the time to hypothyroidism and incidence of transient hypothyroidism.
METHODS: Searches were conducted in MEDLINE, EMBASE, Scopus, and Cochrane library for studies reporting the incidence of hypothyroidism or thyroxine supplementation following hemithyroidectomy.
RESULTS: Sixty-six studies were eligible for inclusion: 36 reported risk factors, and 27 reported post-operative course of hypothyroidism. Median follow-up was 25.2 months. The pooled incidence of hypothyroidism was 29% (95% CI, 25-34%; P<0.001). Transient hypothyroidism occurred in 34% of patients (95% CI, 21-47%; P<0.001). The pooled incidence of thyroxine supplementation was 23% (95% CI, 19-27%; P<0.001), overt hypothyroidism 4% (95% CI, 2-6%, P<0.001). Risk factors for development of hypothyroidism included pre-operative thyroid stimulating hormone (TSH) (WMD, 0.87; 95% CI, 0.75-0.98; P<0.001), TSH ≥ 2 mIU/L (RR, 2.87; 95% CI, 2.43-3.40; P<0.001), female sex (RR, 1.19; 95% CI, 1.08-1.32; P=0.007), age (WMD, 2.29; 95% CI, 1.20-3.38; P<0.001), right sided hemithyroidectomy (RR, 1.35; 95% CI, 1.10-1.65, P=0.003), the presence of autoantibodies anti-TPO (RR, 1.92; 95% CI, 1.49-2.48; P<0.001), anti-Tg (RR, 1.53; 95% CI, 1.40-1.88; P<0.001), and Hashimoto\'s thyroiditis (RR, 2.05; 95% CI, 1.57-2.68; P=0.001).
CONCLUSIONS: A significant number of patients will develop hypothyroidism or require thyroxine following hemithyroidectomy. An awareness of patient risk factors and postoperative thyroid function course will assist in counselling patients on their risk profile and guiding management.
METHODS: Searches were conducted in MEDLINE, EMBASE, Scopus, and Cochrane library for studies reporting the incidence of hypothyroidism or thyroxine supplementation following hemithyroidectomy.
RESULTS: Sixty-six studies were eligible for inclusion: 36 reported risk factors, and 27 reported post-operative course of hypothyroidism. Median follow-up was 25.2 months. The pooled incidence of hypothyroidism was 29% (95% CI, 25-34%; P<0.001). Transient hypothyroidism occurred in 34% of patients (95% CI, 21-47%; P<0.001). The pooled incidence of thyroxine supplementation was 23% (95% CI, 19-27%; P<0.001), overt hypothyroidism 4% (95% CI, 2-6%, P<0.001). Risk factors for development of hypothyroidism included pre-operative thyroid stimulating hormone (TSH) (WMD, 0.87; 95% CI, 0.75-0.98; P<0.001), TSH ≥ 2 mIU/L (RR, 2.87; 95% CI, 2.43-3.40; P<0.001), female sex (RR, 1.19; 95% CI, 1.08-1.32; P=0.007), age (WMD, 2.29; 95% CI, 1.20-3.38; P<0.001), right sided hemithyroidectomy (RR, 1.35; 95% CI, 1.10-1.65, P=0.003), the presence of autoantibodies anti-TPO (RR, 1.92; 95% CI, 1.49-2.48; P<0.001), anti-Tg (RR, 1.53; 95% CI, 1.40-1.88; P<0.001), and Hashimoto\'s thyroiditis (RR, 2.05; 95% CI, 1.57-2.68; P=0.001).
CONCLUSIONS: A significant number of patients will develop hypothyroidism or require thyroxine following hemithyroidectomy. An awareness of patient risk factors and postoperative thyroid function course will assist in counselling patients on their risk profile and guiding management.
摘要：
背景：尚未完全了解半甲状腺切除术后甲状腺功能减退症的发生率以及与其发生相关的危险因素。本系统综述调查了甲状腺功能减退症的发生率和危险因素。甲状腺切除术后补充甲状腺素以及术后甲状腺功能减退症的过程，包括甲状腺功能减退的发生时间和一过性甲状腺功能减退的发生率。
方法：在MEDLINE中进行搜索，EMBASE,Scopus,和Cochrane图书馆的研究报告甲状腺切除术后甲状腺功能减退或补充甲状腺素的发生率。
结果：66项研究符合纳入条件：36项报告的危险因素，27例报告了甲状腺功能减退症的术后过程。中位随访时间为25.2个月。合并的甲状腺功能减退症发生率为29%（95%CI，25-34%；P<0.001）。34%的患者发生暂时性甲状腺功能减退症（95%CI，21-47%；P<0.001）。补充甲状腺素的合并发生率为23％（95％CI，19-27％；P<0.001），明显的甲状腺功能减退症4%(95%CI，2-6%，P<0.001)。甲状腺功能减退的危险因素包括术前促甲状腺激素（TSH）（WMD，0.87；95%CI，0.75-0.98；P<0.001），TSH≥2mIU/L(RR，2.87；95%CI，2.43-3.40；P<0.001），女性（RR，1.19；95%CI，1.08-1.32；P=0.007），年龄(大规模杀伤性武器，2.29；95%CI，1.20-3.38；P<0.001），右侧半甲状腺切除术（RR，1.35；95%CI，1.10-1.65，P=0.003），抗TPO自身抗体的存在(RR，1.92；95%CI，1.49-2.48；P<0.001），反Tg(RR，1.53；95%CI，1.40-1.88；P<0.001），和桥本甲状腺炎(RR，2.05；95%CI，1.57-2.68；P=0.001）。
结论：相当多的患者在甲状腺切除术后会出现甲状腺功能减退或需要甲状腺素。对患者危险因素和术后甲状腺功能过程的认识将有助于指导患者的风险状况和指导管理。
方法：在MEDLINE中进行搜索，EMBASE,Scopus,和Cochrane图书馆的研究报告甲状腺切除术后甲状腺功能减退或补充甲状腺素的发生率。
结果：66项研究符合纳入条件：36项报告的危险因素，27例报告了甲状腺功能减退症的术后过程。中位随访时间为25.2个月。合并的甲状腺功能减退症发生率为29%（95%CI，25-34%；P<0.001）。34%的患者发生暂时性甲状腺功能减退症（95%CI，21-47%；P<0.001）。补充甲状腺素的合并发生率为23％（95％CI，19-27％；P<0.001），明显的甲状腺功能减退症4%(95%CI，2-6%，P<0.001)。甲状腺功能减退的危险因素包括术前促甲状腺激素（TSH）（WMD，0.87；95%CI，0.75-0.98；P<0.001），TSH≥2mIU/L(RR，2.87；95%CI，2.43-3.40；P<0.001），女性（RR，1.19；95%CI，1.08-1.32；P=0.007），年龄(大规模杀伤性武器，2.29；95%CI，1.20-3.38；P<0.001），右侧半甲状腺切除术（RR，1.35；95%CI，1.10-1.65，P=0.003），抗TPO自身抗体的存在(RR，1.92；95%CI，1.49-2.48；P<0.001），反Tg(RR，1.53；95%CI，1.40-1.88；P<0.001），和桥本甲状腺炎(RR，2.05；95%CI，1.57-2.68；P=0.001）。
结论：相当多的患者在甲状腺切除术后会出现甲状腺功能减退或需要甲状腺素。对患者危险因素和术后甲状腺功能过程的认识将有助于指导患者的风险状况和指导管理。
