Follow-up after surgery for benign nodular thyroid disease: evidence-based approach.

BACKGROUND: There is no consensus on what constitutes appropriate methodology and timing for follow-up of patients after surgery for benign nodular disease.

METHODS: A systematic review of the medical literature using evidence-based criteria was used to address the following four issues: (1) How often should patients who have undergone thyroidectomy for the treatment of benign nodular goiter be followed, and what constitutes appropriate follow-up? (2) What is the most appropriate method for detecting recurrent nodular thyroid disease? (3) Does thyroid hormone administration prevent recurrent nodular thyroid disease? (4) Does iodine administration prevent recurrent nodular thyroid disease?

RESULTS: Altogether, 742 articles were found in MEDLINE using a keyword search strategy; we then narrowed them to 23 articles. There were a total of four articles with Level I data, five articles with Level II data, one article with Level III data, and 13 articles with Level IV or retrospective data.

CONCLUSIONS: Based on the available data, it is our recommendation that patients undergoing thyroid lobectomy for benign nodular thyroid disease should be followed with an annual physical examination, neck ultrasonography, and serum thyroid-stimulating hormone (TSH) measurement. Patients undergoing total thyroidectomy should be followed with an annual physical examination and a serum TSH measurement. Routine thyroxine and/or iodine supplementation may be useful for preventing recurrence in patients from iodine-deficient regions.