Hemithyroidectomy seems to be equally beneficial and safer than total thyroidectomy for unilateral medullary thyroid carcinoma (MTC), according to a study recently published in Langerbeck’s Archives of Surgery.
“For patients with unilateral [sporadic MTC], hemithyroidectomy was adequate as a locally curative surgery, because the patients underwent total thyroidectomy did not benefit more from it in the aspects of [biochemical cure]/[overall survival]/[relapse-free survival], while the postoperative increasing incidence rate of postoperative hypocalcemia could not improve patients’ quality of life,” the authors explained.
This retrospective case series included a total of 129 patients previously diagnosed with sporadic MTC, out of which the majority (62%) underwent a hemithyroidectomy, and the remaining 38% a total thyroidectomy. Both groups achieved similar overall survival, biochemical cure, and disease-free survival rates, suggesting that a total thyroidectomy is most likely unnecessary for patients with unilateral MTC.
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Moreover, thyroid surgery represents an important risk for disabling complications. Choosing hemithyroidectomy over a total thyroidectomy will likely lead to fewer chances of voice impairment secondary to vocal cord paralysis since only 1 recurrent laryngeal nerve would be at risk of injury.
Likewise, hypoparathyroidism is also a rare complication when completely avoiding the contralateral thyroid and parathyroid tissue. This highlights the significantly better quality of life individuals with surgically-resected MTC can achieve when undergoing a hemithyroidectomy.
As expected, lateral cervical lymph node invasion, represented by a pathological tumor node metastasis stage, was an important predictor of disease-free survival, regardless of the surgical approach. In this revision, biochemical cure rates of 75% vs 52.7% were observed in patients that underwent lateral lymph node resection compared to those who didn’t, respectively.
Similarly, there was no statistically significant difference in preoperative or postoperative serum calcitonin levels between both groups.
“When hemithyroidectomy had been performed, the extent of the lymph node dissection should be highly emphasized by the preoperative ultrasonography, [computed tomography] scan images, and serum Ctn levels,” the authors concluded.
Zhang J, Gu P, Huang D, Zhao J, Zheng X, Gao M. Surgical selection and prognostic analysis in patients with unilateral sporadic medullary thyroid carcinoma. Langenbecks Arch Surg. Published online June 24, 2022. doi:10.1007/s00423-022-02591-9