Development of painless thyroiditis after thyroid lobectomy in patients with Hashimoto's thyroiditis

Postoperative hypothyroidism, a complication of thyroid lobectomy, occurs frequently. Unique cases of post-lobectomy painless thyroiditis, a pathology not previously reported, were recently observed in our practice. In this study, we aimed to retrospectively investigate the frequency and characteristics of thyroid dysfunction after lobectomy, focusing on painless thyroiditis.

A total of 193 patients with thyroid tumors, including 66 with Hashimoto's thyroiditis and 127 without Hashimoto's thyroiditis, underwent thyroid lobectomy. These patients were followed up for 49.6 (12-118) months.

Thyroid dysfunction occurred in 20.7% of patients, including 31.8% (21/66) and 14.9% (19/127) of those with and without Hashimoto's thyroiditis, respectively. The types of thyroid dysfunction included thyrotoxicosis (10.0%), subclinical hypothyroidism (47.5%), and overt hypothyroidism (42.5%). Nine of 21 patients with Hashimoto's thyroiditis who developed thyroid dysfunction 1-4 months after lobectomy were diagnosed with painless thyroiditis, based on the characteristic transient hypoechogenic pattern on ultrasonography during hormonal fluctuations. Four patients developed thyrotoxicosis, one of whom subsequently become hypothyroid. Thyroid function returned to normal in all four patients. Two patients tested negative for TSH receptor antibody during the thyrotoxic period. The remaining five patients developed hypothyroidism, which was transient in three patients.

Painless thyroiditis develops as post-lobectomy thyroid dysfunction in patients with Hashimoto's thyroiditis. We propose naming this condition "post-lobectomy thyroiditis," as it is believed to be triggered by surgical manipulation of the thyroid gland in individuals with underlying subclinical thyroid autoimmunity. Given its transient nature in most cases, distinguishing this condition from postoperative permanent hypothyroidism is essential.