Total versus subtotal thyroidectomy. Arguments, approaches, and recommendations

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Surgery

Background:

• Debate exists regarding the optimal surgical approach for well-differentiated intrathyroidal carcinoma.
• Existing literature lacks prospective randomized studies and often fails to stratify patients by risk or tumor histology.

Purpose of the Study:

• To evaluate the efficacy and safety of different surgical resection strategies for well-differentiated intrathyroidal carcinoma.
• To provide guidance on selecting appropriate surgical techniques based on patient risk and intraoperative assessment.

Main Methods:

• Review of existing literature comparing total thyroidectomy, subtotal thyroidectomy, and unilateral resection.
• Analysis of factors influencing surgical decision-making, including tumor characteristics, patient risk stratification (e.g., AGES criteria), and surgeon experience.
• Intraoperative assessment of anatomical landmarks (laryngeal nerves, parathyroid glands) and tumor extent.

Main Results:

• Bilateral subtotal resection demonstrates comparable results to total thyroidectomy in the majority of intrathyroidal, well-differentiated lesions.
• Unilateral resection (lobectomy plus isthmusectomy) is suitable for low-risk patients with small, unilateral tumors and no metastatic disease.
• Total thyroidectomy is recommended selectively for experienced surgeons when anatomical structures are clearly identifiable and risks are minimal.

Conclusions:

• Subtotal thyroidectomy may be preferred over total thyroidectomy due to a potentially more favorable complication profile.
• Surgeons must individualize complication rates and selectively employ total thyroidectomy, reverting to subtotal resection if increased risk to nerves or parathyroids is identified.
• Patient selection and intraoperative judgment are crucial for optimizing outcomes in well-differentiated intrathyroidal carcinoma surgery.