Recurrence risk of differentiated thyroid cancer treated with total or hemithyroidectomy: systematic review and...

Differentiated thyroid carcinoma (DTC) is traditionally treated with total thyroidectomy (TT); however, hemithyroidectomy (HT) has been increasingly used. Previous analyses on DTC recurrence rate with HT and TT have yielded inconsistent results; this study aimed to bridge this gap.

Searches were conducted in PubMed/MEDLINE and Embase. Furthermore, references of previous systematic reviews were screened to extend the search until May 2025. Specific data on recurrence rate were independently extracted from the included studies by two observers and then pooled using a random-effect model. The primary endpoint was the risk difference (RD) in cancer recurrence rate between HT and TT. The secondary endpoints included recurrence prevalence (RP) for TT and HT and odds ratio (OR) comparing HT with TT.

A total of 2,556 papers were initially identified, and 46 retrospective studies were included. The overall quality of the studies was satisfactory. In total, 98,604 patients were treated with TT (n = 75,531) or HT (n = 23,073). The proportion meta-analyses revealed a pooled RP of 5.8% in TT and 8.1% in HT. The HT group had a significantly higher probability of DTC recurrence than the TT group (OR = 1.56, 95% CI = 1.47-1.66, I 2 = 85%). The RD meta-analysis revealed that the recurrence rate was significantly higher in the HT group than in the TT group, by 3% (95% CI = 3-4, I 2 = 87%).

The DTC recurrence rate following HT is significantly higher than that observed following TT. Thyroid specialists should consider this finding when tailoring initial treatment strategies.