Post-thyroidectomy hypothyroidism and thyroid hormone supplementation: a narrative review of the history, treatment, and patient experience

Background and Objective: Surgical management of thyroid disease bears risk of need for lifelong thyroid hormone supplementation in patients undergoing partial thyroidectomy, with a guarantee in those undergoing total or subtotal thyroidectomy. The aim of this study is to review the evidence-based management of thyroid hormone supplementation in the post-surgical setting, and to better understand quality of life (QoL) considerations in the post-thyroidectomy population. Specific emphasis is placed on management of the patient with differentiated thyroid cancer (DTC), both from management and QoL perspectives. Methods: Review of English language studies on history, diagnosis and management of hypothyroidism following thyroidectomy, as well as relevant QoL assessment, conducted by authors February to May of 2022. Key Content and Findings: Treatment of primary hypothyroidism following thyroidectomy may warrant a multidisciplinary and nuanced approach. QoL may be significantly impacted in certain post-surgical cohorts, including patients with DTC and autoimmune thyroiditis, with special consideration and treatment algorithms warranted in managing these patients. Conclusions: Optimizing treatment algorithms for initiation and adjustment of thyroid hormone supplementation is crucial to elevate patient outcomes with respect to both physiology and QoL. Regular assessment of QoL may guide providers toward new treatment methods and optimize patient experience in the setting of post-operative hypothyroidism.