From the Guidelines
A total thyroidectomy is generally recommended over a hemithyroidectomy in cases of radiation-induced thyroid disease and when there is a significant family history of thyroid cancer, as stated in the guidelines by the European Society for Medical Oncology 1 and the National Comprehensive Cancer Network 1. The initial treatment for differentiated thyroid carcinoma (DTC) should always be preceded by careful exploration of the neck by ultrasound to assess the status of lymph node chains. The guidelines recommend total or near-total thyroidectomy whenever the diagnosis is made before surgery and the nodule is ≥1 cm, or regardless of the size if there is metastatic, multifocal, or familial DTC 1. For radiation-induced thyroid pathology, total thyroidectomy is preferred because radiation exposure increases the risk of multifocal disease and malignant transformation throughout the entire gland. Similarly, in patients with a family history of thyroid cancer, particularly medullary thyroid cancer or as part of syndromes like Multiple Endocrine Neoplasia (MEN), the genetic predisposition often affects both lobes, making complete removal necessary. Total thyroidectomy in these cases provides better disease control, reduces the risk of recurrence, and eliminates the need for reoperation if cancer is found in the remaining tissue. However, this approach requires lifelong thyroid hormone replacement therapy and carries slightly higher risks of complications such as recurrent laryngeal nerve injury and hypoparathyroidism compared to hemithyroidectomy. The decision should be individualized based on the specific clinical scenario, extent of disease, and patient factors, as outlined in the guidelines by the National Comprehensive Cancer Network 1. Some key points to consider when deciding between a total and hemi thyroidectomy include:
- The presence of radiation-induced thyroid disease or a significant family history of thyroid cancer
- The size and location of the nodule
- The presence of metastatic, multifocal, or familial disease
- The patient's overall health and risk factors for complications. It is essential to weigh the benefits and risks of each approach and consider the individual patient's needs and circumstances when making a decision. The most recent guidelines from the National Comprehensive Cancer Network 1 provide a comprehensive framework for managing thyroid carcinoma, including recommendations for total thyroidectomy in certain cases. By following these guidelines and considering the individual patient's needs, healthcare providers can make informed decisions about the best course of treatment for patients with thyroid cancer.
From the Research
Total vs Hemi Thyroidectomy
When deciding between a total and a hemi thyroidectomy, several factors should be considered:
- Radiotherapy induced: There is no direct evidence from the provided studies to support the use of total thyroidectomy over hemi thyroidectomy in cases of radiotherapy-induced thyroid cancer 2, 3, 4, 5, 6.
- Family history: The studies do not provide information on the impact of family history on the decision between total and hemi thyroidectomy 2, 3, 4, 5, 6.
Indications for Total Thyroidectomy
Some studies suggest that total thyroidectomy may be considered in certain cases, such as:
- Bilateral thyroid cancer: Total thyroidectomy may be necessary for patients with bilateral thyroid cancer or those with a high risk of recurrence 3, 5.
- Large tumors: Total thyroidectomy may be considered for patients with large tumors or those with extrathyroidal extension 3, 5.
Complications and Quality of Life
The studies suggest that:
- Complication rates: Total thyroidectomy may have higher complication rates, such as hypocalcemia and nerve injury, compared to hemi thyroidectomy 3, 4, 5.
- Quality of life: Long-term quality of life may not differ significantly between patients who undergo total thyroidectomy and those who undergo hemi thyroidectomy 6.