From the Guidelines
Hemithyroidectomy is indicated for patients with well-differentiated thyroid cancers less than 4 cm confined to one lobe without evidence of extrathyroidal extension or lymph node involvement, as well as for those with indeterminate thyroid nodules, symptomatic unilateral goiters, solitary toxic nodules, and suspicious nodules with inconclusive fine needle aspiration results. The primary goal of this procedure is to balance the need for tissue diagnosis or symptom relief while preserving thyroid function when possible, avoiding the lifelong hormone replacement that total thyroidectomy would necessitate 1.
Indications for Hemithyroidectomy
- Indeterminate thyroid nodules that require definitive diagnosis
- Symptomatic unilateral goiters causing compression or cosmetic concerns
- Solitary toxic nodules causing hyperthyroidism
- Well-differentiated thyroid cancers less than 4 cm confined to one lobe without evidence of extrathyroidal extension or lymph node involvement
- Suspicious nodules with inconclusive fine needle aspiration results (Bethesda III or IV)
- Follicular neoplasms or Hürthle cell neoplasms where malignancy cannot be ruled out without examining the entire nodule
- Asymmetric multinodular goiters causing compressive symptoms like dysphagia, voice changes, or breathing difficulties
Post-Operative Management
Following hemithyroidectomy, most patients maintain normal thyroid function with the remaining lobe, though approximately 20-30% may require thyroid hormone supplementation (typically levothyroxine starting at 1.6 mcg/kg/day) 1. This approach is supported by recent guidelines, which emphasize the importance of individualized treatment and follow-up plans for patients with thyroid cancer 1.
Key Considerations
- The decision to perform hemithyroidectomy should be based on a thorough evaluation of the patient's overall health, the characteristics of the thyroid nodule or cancer, and the potential risks and benefits of the procedure 1.
- Patients should be closely monitored after surgery for any signs of complications or recurrence, and should receive regular follow-up care to ensure optimal outcomes 1.
From the Research
Indications for Hemithyroidectomy
The indications for hemithyroidectomy are as follows:
- Single toxic or euthyroid nodule with a healthy contralateral lobe 2
- Indeterminate follicular lesions diagnosed by fine-needle aspiration cytology 3, 4, 5
- Low-risk thyroid cancer, as recommended by the American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) thyroid cancer guidelines 6
- Unilateral goiter, where hemithyroidectomy is preferred to avoid the risk of complications and hormone replacement therapy 2, 4
Benefits and Risks of Hemithyroidectomy
The benefits of hemithyroidectomy include:
- Avoiding the risk of hypocalcemia, with a rate of 6% in total thyroidectomy compared to zero in hemithyroidectomy 2
- Lower risk of postoperative complications, such as recurrent laryngeal nerve palsy and hematoma 2, 3
- Avoiding the need for hormone replacement therapy in some patients 2, 3
However, hemithyroidectomy also carries the risk of:
- Completion thyroidectomy due to the discovery of carcinoma, with a rate of 11.3% in one study 2
- Subsequent surgery, with a rate of 10.52% in another study 3
Postoperative Management
Postoperative management of hemithyroidectomy patients includes: