Skip to main content
SpringerLink
Log in

Hemithyroidectomy for Differentiated Thyroid Cancer

  • Chapter
  • First Online:
Innovations in Modern Endocrine Surgery

  • 464 Accesses

Abstract

There has been a renewed interest in minimalistic, initial management options for low-risk thyroid cancer over the last several years. Recent guidelines endorse a much more risk-adapted surgical management approach, allowing hemithyroidectomy as an alternative to total thyroidectomy for intrathyroidal, well-differentiated thyroid cancer tumors up to 4 cm in maximal diameter. In this chapter, we describe a clinical framework to classify patients as ideal, appropriate, or inappropriate for a hemithyroidectomy, which takes into account three major domains—tumor and imaging results; patient characteristics and preferences; and disease management team characteristics and treatment philosophy—in the pre-operative, intra-operative, and post-operative periods.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tarasova VD, Tuttle RM. A risk-adapted approach to follow-up in differentiated thyroid cancer. Rambam Maimonides Med J. 2016;7(1):e0004. https://doi.org/10.5041/RMMJ.10231.

    Article  PubMed Central  Google Scholar 

  2. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.

    Article  Google Scholar 

  3. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma. 2.2019; https://www.nccn.org/professionals/physician_gls/PDF/thyroid.pdf. Accessed 11 June 2020.

  4. Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol. 2011;18(3):767–70.

    Article  Google Scholar 

  5. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2015;26(1):144–9.

    Article  Google Scholar 

  6. Tuttle M, Zhang L, Shaha A. A clinical framework to facilitate selection of patients with differentiated thyroid cancer for active surveillance or less aggressive initial surgical management. Expert Rev Endocrinol Metab. 2018;13(2):77–85.

    Article  CAS  Google Scholar 

  7. Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin N Am. 2014;43(2):401–21.

    Article  Google Scholar 

  8. Momesso DP, Vaisman F, Yang SP, et al. Dynamic risk stratification in patients with differentiated thyroid cancer treated without radioactive iodine. J Clin Endocrinol Metab. 2016;101(7):2692–700.

    Article  CAS  Google Scholar 

  9. Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–81; discussion 381–374.

    Article  Google Scholar 

  10. Adam MA, Pura J, Gu L, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260(4):601–5; discussion 605–607.

    Article  Google Scholar 

  11. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. 2005;12(1):81–9.

    Article  Google Scholar 

  12. Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD. Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck. 2011;33(5):645–9.

    Article  Google Scholar 

  13. Mendelsohn AH, Elashoff DA, Abemayor E, St John MA. Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg. 2010;136(11):1055–61.

    Article  Google Scholar 

  14. Nixon IJ, Ganly I, Patel SG, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012;151(4):571–9.

    Article  Google Scholar 

  15. Matsuzu K, Sugino K, Masudo K, et al. Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J Surg. 2014;38(1):68–79.

    Article  Google Scholar 

  16. Liu J, Zhang Z, Huang H, et al. Total thyroidectomy versus lobectomy for intermediate-risk papillary thyroid carcinoma: a single-institution matched-pair analysis. Oral Oncol. 2019;90:17–22.

    Article  Google Scholar 

  17. Choi JB, Lee SG, Kim MJ, et al. Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy. Head Neck. 2019;41(1):56–63.

    PubMed  Google Scholar 

  18. Gartland RM, Lubitz CC. Impact of extent of surgery on tumor recurrence and survival for papillary thyroid cancer patients. Ann Surg Oncol. 2018;25(9):2520–5.

    Article  Google Scholar 

  19. Vargas-Pinto S, Romero Arenas MA. Lobectomy compared to total thyroidectomy for low-risk papillary thyroid cancer: a systematic review. J Surg Res. 2019;242:244–51.

    Article  Google Scholar 

  20. Zambeli-Ljepović A, Wang F, Dinan MA, et al. Extent of surgery for low-risk thyroid cancer in the elderly: equipoise in survival but not in short-term outcomes. Surgery. 2019;166(5):895–900.

    Google Scholar 

  21. Vaisman F, Momesso D, Bulzico DA, et al. Thyroid lobectomy is associated with excellent clinical outcomes in properly selected differentiated thyroid cancer patients with primary tumors greater than 1 cm. J Thyroid Res. 2013;2013:398194.

    Article  Google Scholar 

  22. Vaisman F, Shaha A, Fish S, Tuttle R. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol. 2011;75(1):112–9.

    Article  CAS  Google Scholar 

  23. Groopman J, Hartzband P. Your medical mind. How to decide what is right for you. New York: Penguin Books; 2011.

    Google Scholar 

  24. Scherer LD, Caverly TJ, Burke J, et al. Development of the medical maximizer-minimizer scale. Health Psychol. 2016;35(11):1276–87.

    Article  Google Scholar 

  25. Groopman JE, Hartzband P. National Center for Complementary and Integrative Health (U.S.). When experts disagree: the art of medical decision making. In: Stephen E Straus distinguished lecture in the science of complementary health therapies. National Institutes of Health: Bethesda; 2015. http://videocast.nih.gov/launch.asp?18989.

    Google Scholar 

  26. Ahn JH, Yi JW. Transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases. Surg Endosc. 2020;34(2):861–7.

    Article  Google Scholar 

  27. Park JO, Anuwong A, Kim MR, Sun DI, Kim MS. Transoral endoscopic thyroid surgery in a Korean population. Surg Endosc. 2019;33(7):2104–13.

    Article  Google Scholar 

  28. Randolph GW, Daniels GH. Radioactive iodine lobe ablation as an alternative to completion thyroidectomy for follicular carcinoma of the thyroid. Thyroid. 2002;12(11):989–96.

    Article  Google Scholar 

  29. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.

    PubMed  PubMed Central  Google Scholar 

  30. Calcatera NA, Lutfi W, Suman P, et al. Concordance of preoperative clinical stage with pathological stage in patients >/= 45 years with well-differentiated thyroid cancer. Endocr Pract. 2018;24(1):27–32.

    Article  Google Scholar 

  31. Kluijfhout WP, Pasternak JD, Drake FT, et al. Application of the new American Thyroid Association guidelines leads to a substantial rate of completion total thyroidectomy to enable adjuvant radioactive iodine. Surgery. 2017;161(1):127–33.

    Article  Google Scholar 

  32. DiMarco AN, Wong MS, Jayasekara J, et al. Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy. BJS Open. 2019;3(3):299–304.

    Article  CAS  Google Scholar 

  33. Dhir M, McCoy KL, Ohori NP, et al. Correct extent of thyroidectomy is poorly predicted preoperatively by the guidelines of the American Thyroid Association for low and intermediate risk thyroid cancers. Surgery. 2018;163(1):81–7.

    Article  Google Scholar 

  34. Park JH, Yoon JH. Lobectomy in patients with differentiated thyroid cancer: indications and follow-up. Endocr Relat Cancer. 2019;26(7):R381–93.

    Article  Google Scholar 

  35. Lee MC, Kim MJ, Choi HS, et al. Postoperative thyroid-stimulating hormone levels did not affect recurrence after thyroid lobectomy in patients with papillary thyroid cancer. Endocrinol Metab (Seoul). 2019;34(2):150–7.

    Article  CAS  Google Scholar 

  36. Park S, Kim WG, Han M, et al. Thyrotropin suppressive therapy for low-risk small thyroid cancer: a propensity score-matched cohort study. Thyroid. 2017;27(9):1164–70.

    Article  CAS  Google Scholar 

  37. Park S, Jeon MJ, Oh HS, et al. Changes in serum thyroglobulin levels after lobectomy in patients with low-risk papillary thyroid cancer. Thyroid. 2018;28(8):997–1003.

    Article  CAS  Google Scholar 

Download references

Financial Disclosure

The authors have no relevant financial conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Medicine, Endocrinology Service, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina

    Jorgelina Luz Guerra

  2. Division of Subspeciality Medicine, Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    R. Michael Tuttle

Authors
  1. Jorgelina Luz Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Michael Tuttle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Michael Tuttle .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, Henry Ford Hospital System, Detroit, MI, USA

    Michael C. Singer

  2. Department Otolaryngology and Endocrinology, Augusta University Thyroid and Parathyroid Center, Augusta University, Augusta, GA, USA

    David J. Terris

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Guerra, J.L., Tuttle, R.M. (2021). Hemithyroidectomy for Differentiated Thyroid Cancer. In: Singer, M.C., Terris, D.J. (eds) Innovations in Modern Endocrine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-73951-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-73951-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-73950-8

  • Online ISBN: 978-3-030-73951-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation