Hemithyroidectomy provides lower risks, similar benefits as total thyroidectomy for DTC
Adults with differentiated thyroid cancer who underwent hemithyroidectomy had lower risks for surgical complications compared with those who had total or near-total thyroidectomy, according to study data.
“Patients that underwent hemithyroidectomy procedure exhibited similar structural persistent/recurrent disease risk as those [who] underwent total or near total thyroidectomy,” Xuejun Li, MD, PhD, professor, and Fangsen Xiao, MD, assistant professor, both in the department of endocrinology and metabolism at The First Affiliated Hospital of Xiamen University, told Healio. “It may be feasible to choose hemithyroidectomy as initial procedure in 1 - 4cm differentiated thyroid cancer without clinically recognized high-risk features.”
Researchers conducted a retrospective cohort study of 795 adults with confirmed differentiated thyroid cancer and a tumor between 1 cm and 4 cm in diameter who underwent initial thyroid surgery at The First Affiliated Hospital of Xiamen University from January 2008 to July 2018. Data on age, sex, surgery management, pathology, radioactive iodine administration and duration of follow-up were obtained. Participants were divided by surgical procedure into a hemithyroidectomy group (n = 286) and a group that underwent a total or near-total thyroidectomy (n = 509). Persistent or recurrent disease and treatment-associated adverse events, including reoperation rate, surgical complications and levothyroxine replacement, were compared between the two groups.
The findings were published in Clinical Endocrinology.
During a median follow-up period of 56.5 months, 10 people in the hemithyroidectomy group and 12 in the total thyroidectomy group developed persistent or recurrent disease, with no significant difference observed between the two groups. Two people in the hemithyroidectomy and four in the total thyroidectomy group developed distant organ metastasis.
Adults in the hemithyroidectomy group were less likely to have surgical complications compared with those who had a total thyroidectomy (OR = 0.47; 95% CI, 0.31-0.71; P < .001). The odds for permanent hypoparathyroidism (OR = 0.16; 95% CI, 0.05-0.54; P = .003) and transient hypoparathyroidism (OR = 0.36; 95% CI, 0.18-0.72; P = .004) also were lower in the hemithyroidectomy group. The proportion of adults in the hemithyroidectomy group who required levothyroxine replacement therapy was also lower compared with those who underwent a total thyroidectomy (OR = 0.44; 95% CI, 0.2-0.95; P = .007).
“The surgical extent was not an independent factor associated with the development of structural persistent/recurrent disease in these patients,” Li and Xiao said. “Hemithyroidectomy provides better balance of benefits and harms as compared with total or near total thyroidectomy.”
Li and Xiao said a large multicenter prospective cohort study with a long-term follow-up is needed to confirm the findings.
For more information:
Xuejun Li, MD, PhD, can be reached at lixuejun@xmu.edu.cn.
Fangsen Xiao, MD, can be reached at xfs888@xmu.edu.cn.
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