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Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient’s characteristics, and risk factors

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Abstract

Purpose

This study was aimed at assessing the incidence and timing of thyroid nodules recurrence, defined as appearance of new benign or malignant nodules in contralateral lobe in patients with benign thyroid nodules or thyroid microcarcinoma treated with lobo-isthmectomy. Patient’s characteristics and risk factors associated with this phenomenon were also investigated.

Methods

A retrospective study was performed by evaluating 413 patients undergoing lobo-isthmectomy with a minimum follow-up of 1 year. Clinical characteristics, surgical interventions and complications, histological diagnosis, and thyroid function at last follow-up were collected.

Results

Single or multiple thyroid nodule recurrence equally occurred in 80 patients (23%) with a median time to relapse of ~ 5 years (range 0.3–34.5 years) after lobo-isthmectomy. Recurrence was significantly associated with younger age (< 46 years) and number of pregnancies in women. Development of hypothyroidism was not rare either (~ 10%) and appeared in 3–19 months; a preoperative TSH level > 2.43 mIU/L was associated with the need of l-thyroxin replacement therapy after surgery. The most frequent surgical complication was transient hypoparathyroidism (4.6%), while the rate of permanent hypoparathyroidism significantly increased in patients submitted to completion thyroidectomy (5.3%).

Conclusions

Thyroid nodules recurrence following lobo-isthmectomy is not a rare event and occurs within 5 years after surgery, more frequently in younger patients with family history of nodular goiter and in women with multiple pregnancies. Pre-surgical TSH levels may predict the development of post-surgical hypothyroidism, possibly improving the management of patients addressed to surgery.

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Authors and Affiliations

  1. Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy

    M. C. Zatelli & L. Damiani

  2. Department of Internal Medicine and Medical Specialties, University of Rome ‘Sapienza’, Rome, Italy

    L. Lamartina, G. Grani & C. Durante

  3. Endocrinology Unit, AUSL Bologna-Bentivoglio Hospital, Bologna, Italy

    D. Meringolo

  4. Division of Oncological Endocrinology, Department of Medical Sciences, Azienda Ospedaliera Città DELLA Salute E Della Scienza, Turin, Italy

    E. Arvat & A. Nervo

  5. Department of Surgical Sciences, University of Rome ‘Sapienza’, Rome, Italy

    L. Giacomelli

Authors
  1. M. C. Zatelli
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  2. L. Lamartina
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  4. E. Arvat
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  6. G. Grani
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  8. C. Durante
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  9. L. Giacomelli
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Contributions

GG and LL contributed to this paper as recipients of the PhD program of Biotechnologies and Clinical Medicine of the University of Rome, Sapienza.

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Correspondence to M. C. Zatelli.

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Cite this article

Zatelli, M.C., Lamartina, L., Meringolo, D. et al. Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient’s characteristics, and risk factors. J Endocrinol Invest 41, 1469–1475 (2018). https://doi.org/10.1007/s40618-018-0946-5

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  • DOI: https://doi.org/10.1007/s40618-018-0946-5

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