Survival after hemithyroidectomy versus total thyroidectomy in non-high-risk differentiated thyroid cancer: population-based analysis

Abstract

Background The extent of thyroid surgery remains controversial for differentiated thyroid cancers (DTCs) that measure more than 1 cm but are not considered high risk. This study aimed to compare survival outcomes between hemithyroidectomy (HT) and total thyroidectomy (TT) in non-high-risk DTCs. Methods A population-based retrospective cohort of patients with non-high-risk DTCs more than 1 cm undergoing HT or TT between 1997 and 2017 in a territory with 41 public hospitals and clinics serving a population of 7 million was analysed. Multivariable Cox proportional hazards regression models adjusted for patient demographics and clinical parameters were used to compare the overall, disease-specific, and recurrence-free survival between TT and HT. Risks of postoperative complications were compared between the two groups. Results A total of 4771 patients (HT, 1368; TT, 3403) underwent thyroid surgery as a primary treatment. Median (range) follow-up was 117 (range: 72–179) months. Patients in the TT and HT groups had comparable risks of overall survival (HR 0.87; 95 per cent c.i. 0.73 to 1.04; P = 0.119) and disease-specific survival (HR 0.85; 95 per cent c.i. 0.52 to 1.40; P = 0.518). The TT group had better recurrence-free survival (HR 0.37; 95 per cent c.i. 0.26 to 0.52; P < 0.001) than the HT group. The temporary and permanent hypoparathyroidism rates in TT group were 14.96 per cent and 7.49 per cent respectively; none were reported in the HT group. Conclusions Despite the comparable overall and disease-specific survivals, TT was associated with better recurrence-free survival than HT in a 10-year follow-up. This was at the expense of higher surgical morbidity rate in TT.

Distinguishing benign and malignant thyroid nodules using plasma trimethylamine N-oxide, carnitine, choline and betaine

“…size, location, homogeneity and vascularity of the nodule) (Blum 2000 ). Although the overall survival rate of TC is relatively high, early diagnosis is still of paramount importance (Liu et al 2022b ). Identifying effective early diagnostic TC biomarkers can minimize the need for unnecessary biopsies, prevent the misdiagnosis or undertreatment of a curable cancer, and to some extent relieve the patient’s anxiety (Sakorafas et al 2010 ).…”

Evaluation of the quality of thyroidectomy‐related posts on a video‐based social media platform

“…Thyroid disease tends to affect a younger demographic, and thyroid surgery is often recommended for a variety of indications 2,3 . While it is generally associated with good outcomes, there are a variety of treatment‐related effects and risks with thyroidectomy 1,4–6 . Postoperatively, patients may require lifelong medication and continued medical care with or without oncologic follow‐up 3 .…”

“… 2 , 3 While it is generally associated with good outcomes, there are a variety of treatment‐related effects and risks with thyroidectomy. 1 , 4 , 5 , 6 Postoperatively, patients may require lifelong medication and continued medical care with or without oncologic follow‐up. 3 In addition, either as complications or expected effects from surgery, patients must cope with quality of life issues ranging from hypothyroidism and hypoparathyroidism symptoms, transient voice and swallowing disturbances, 8 neuropsychiatric symptoms, and body image concerns related to scarring in a cosmetically sensitive area.…”