Effect and long-term outcome of hemithyroidectomy for patients with low-risk papillary thyroid carcinoma

Abstract

Background Although the incidence of papillary thyroid carcinoma (PTC) has increased during the recent years, most of the PTCs are slow growing and considered as low-risk tumors with an excellent prognosis. This observed increase in small tumors leads to many controversies regarding the optimal surgical approach, and the extent of surgery for low-risk PTC is still the subject of debate. Recently, there is a trend toward utilizing a less-aggressive surgical approach, including the option of hemithyroidectomy for small PTCs up to 4 cm. Patients and methods This study included 60 patients with a proven diagnosis of PTC. According to the guidelines of the British Thyroid Association, the American Thyroid Association, and the American Joint Committee on Cancer, these patients would have low-risk PTCs and considered eligible for hemithyroidectomy (total lobectomy with isthmusectomy) as an initial treatment and followed up for about 5 years to detect recurrence and survival rate. Results Hemithyroidectomy was performed as an initial treatment. Completion thyroidectomy (CTx) was performed in five (8.33%) patients in the postoperative period within 1 week after the initial operation owing to identifying high-risk features in the final histopathology. During the follow-up period of the 60 patients, there was no locoregional recurrence. Recurrence was observed in three (5%) patients in the contralateral thyroid lobe within 3–4 years and was treated with a second surgery in the form of CTx. The overall rate of CTx was eight (13.33%) of 60 patients. The prognosis and the 5-year survival rate were excellent (100%). Conclusion Hemithyroidectomy in appropriately selected patients is an optimal surgical approach for treating low-risk PTC, and if recurrence occurs in the contralateral lobe, it can be treated safely by CTx, which yielded excellent curative results.

Keywords

• completion thyroidectomy
• hemithyroidectomy
• low-risk papillary thyroid carcinoma
• recurrence