Thyroid Lobectomy With or Without Levothyroxine Treatment Postoperatively
Condition: Recurrent Goiter
MeSH terms: Goiter
Study type: Observational

Summary: 
      The aim of this study was to compare the prevalence of recurrent nodular goiter in the
      contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral
      multinodular goiter receiving versus not receiving prophylactic levothyroxine treatment
      postoperatively in a five-year follow-up of a randomized study
    

Detailed description: 
      It is commonly accepted that in patients with benign nodular thyroid disease who undergo
      operative therapy, surgical resection consists of lobectomy for patients with disease limited
      to one lobe. Contralateral disease is excluded in such cases by preoperative palpation,
      ultrasonography of the neck, and intraoperative palpation. On the other hand, the preferred
      operative procedure for bilateral nodular thyroid disease is total thyroidectomy. Such a
      treatment strategy minimizes the risk of development of recurrent disease and diminishes the
      risk of complications when reoperation for recurrent nodular thyroid disease becomes
      necessary. The recurrence rate for unilateral thyroidectomy of benign nodular goiter
      performed by expert surgeons has been reported to vary from 10% to 26%. Potential risk
      factors for recurrence of nodular goiter have been evaluated in many studies and include:
      young age at presentation, female gender, positive family history of goiter, long duration of
      symptoms, mutinodularity of thyroid disease, high volume of left thyroid tissue. However,
      most studies evaluating the incidence of recurrent nodular disease are retrospective, and it
      is difficult to determine whether the recurrence represents de novo nodule formation in a
      previously normal thyroid remnant or progression of residual disease left at initial
      operation.

      It is well known fact, that most patients after thyroid lobectomy are euthyroid (60%-90%) and
      do not require thyroid hormone replacement therapy. However, it is an important question
      whether thyroid hormone administration postoperatively can prevent recurrent nodular thyroid
      disease in euthyroid hemithyroidectomized patients? The aim of the present randomized study
      was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe
      among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG)
      receiving versus not receiving prophylactic levothyroxine (LT4) treatment postoperatively in
      a five-year follow-up.
    

Intervention name(s): levothyroxine; no levothyroxine
Intervention type(s): Drug; Drug
Intervention description(s): levothyroxine 75-125 ug/day; observation only without prophylactic levothyroxine
Other intervention name(s): LT4(+); LT4(-)
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        primary care clinic
      
Keywords: Thyroid lobectomy,; prophylactic levothyroxine treatment,; recurrent nodular goiter,; iodine deficiency,; long-term follow-up,; completion thyroidectomy