[Thyreotrophic hypophysial function after surgery for euthyroid goiter or autonomous adenoma]

44 euthyroid patients with nodular goiter and 23 patients with autonomous adenomas were treated by hemithyrectomy or subtotal thyrectomy. Thyroid function was followed over 6 weeks post-operation by TRH tests, which were performed before and at the 5th, 14th, 28th and 42nd day after operation. Bilateral subtotal thyrectomized patients with euthyroid goiter showed a continous increase of basal and TRH stimulated TSH level into the hypothyroid range. 19 of 25 patients were hypothyroid 6 weeks after operation. In contrast, 14 of 19 hemithyrectomized patients with euthyroid goiters remained euthyroid during the time investigated; 5 patients showed a transient TSH increase into the hypothyroid range but were euthyroid again after 6 weeks. TSH levels obtained from patients operated for autonomous adenoma may not yet reflect thyroid function during the time interval investigated here. We conclude that all patients with euthyroid goiter after bilateral subtotal thyrectomy should receive hormone substitution because they are at high risk to develop recurrency. However, we propose that in patients hemithyrectomized for euthyroid goiters the decision of long term hormone substitution should be cased on the result of a TRH-test 3--4 month after operation. Substitution with thyroid hormone should be preferred to iodide because it is unclear yet how far a failure in iodide organification and hormone synthesis is the reason for goiter recurrency.