[Integration of Molecular, Genetic, and Surgical Evidence Into the Indication Criteria for Preventive Thyroid...

Preventive thyroid surgery aims to prevent the occurrence of malignant diseases or improve their prognosis. The main indication is hereditary medullary thyroid carcinoma, which is caused by pathogenic RET germline variants. Other clinical manifestations can also occur in the context of multiple endocrine neoplasia. Early prophylactic thyroidectomy in the asymptomatic stage can make this tumour entity curable. The timing of surgery depends on the genotype and the associated risk classification and calcitonin levels, with particularly aggressive mutations requiring intervention as early as the first year of life.In contrast, the benefit of prophylactic lymph node dissection in papillary thyroid carcinoma remains controversial: While individual studies show a reduction in the recurrence rate, the risk of postoperative complications such as hypoparathyroidism or recurrent nerve palsy is increased. Therefore, the current guideline recommends an individualised approach with risk-adapted indications, taking into account tumour size, histology, and molecular markers.Although thyroid removal eliminates the risk of cancer, it requires lifelong hormone replacement therapy and close follow-up care. Extending the procedure to include prophylactic lymphadenectomy can increase morbidity.Future developments in molecular genetic diagnostics and refined risk stratification should help identify patients with high cancer risk even more precisely and, at the same time, avoid unnecessary interventions. Overall, preventive thyroid surgery is a successful example of personalised prevention, with indications that are becoming increasingly differentiated and patient-oriented.