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Background: Hemithyroidectomy is a frequent treatment for thyroid nodules. Postoperative hypothyroidism is an often underestimated complication. We studied the incidence, time, symptoms and risk factors of postoperative hypothyroidism., Material and Methods: 127 Patients were analyzed in a retrospective chart review and with a structured assessment of the general practitioners and endocrinologists. Patients were classified according to the postoperative TSH as hypothyroid (>4.0 mU/L) or euthyroid (0.4-4.0 mU/L). Thyroid hormone was assessed at 4-6 Weeks, 6 months and 1 year., Results: 55 patients (43 %) had postoperative hypothyroidism and 72 (57%) stayed euthyroid during follow up. The hypothyroidism occured during the first 2 months in 39 patients (71 %), between 2-6 months in 13 patients (24 %) and between 6-12 months in 3 patients (5 %). 33 patients (60 %) with hypothyroidism were asymptomatic and 16 patients (29 %) had symptoms. Preoperative TSH level was significantly higher in the hypothyroid group (1.64) compared to the euthyroid group (1.13, P = 0.0017). The other variables as age, gender, preoperative levels of T3, T4, Calcium and PTH showed no significant difference., Conclusion: Postoperative hypothyroidism is an important complication after hemithyroidectomy which should not be missed. Preoperative elevated TSH level is a riskfactor for postoperative hypothyroidism. All Patients after hemithyroidectomy should have postoperative TSH assessment after 4-6 weeks, 6 months and 12 months., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)