Total Thyroidectomy Versus Hemi-Thyroidectomy in Management of Follicular Lesion Thyroid Nodule

Abstract Background: Thyroid nodules are common condition. It is estimated that 3% to 7% of world population have palpable thyroid nodules, and this prevalence might reach 76% when US is used as a screening tool. When a thyroid nodule is detected, the most important step in the assessment is to determine if it is malignant or not, which is determined via fine needle aspiration biopsy (FNAC). It is accepted that approximately 5% of all nodules are malignant. Aim of Study: To determine the optimal surgical strategy for individuals undergoing surgery for follicular lesion thyroid nodule on preoperative fine needle aspiration biopsy (FNA). Patients and Methods: This was a comparative prospective randomized study conducted on a total of 52 patients diagnosed with follicular lesion thyroid nodule. They will be chosen form Ain Shams University Hospital, El-Demerdash and Damietta Cancer Institute (DCI) after obtaining the approval from ethical committee of the department of surgery, Faculty of Medicine, Ain Shams University. Results: Overall rate of malignancy in follicular lesion thyroid nodule is 34.6% of the studied cases. The higher rate of malignancy was among patients older than 45 years. Clinical and demographic data are not significant in expecting malignant nodules. Only TIDADS 5 category in radiological assessment is the item of statistical significance in expecting malignant pathology. Nodule size has no benefit in detecting malignancy and, consequently, deciding the proper procedure for manage-ment. Hemithyroidectomy is significantly shorter in time and lesser in pain than total thyroidectomy. No permanent compli-cations were reported in the studied cases. In total thyroidec-tomy group, tracheostomy and hypocalcemia were detected in two patients, one for each, and two patients were presented with hoarseness of voice and all of them were completely resolved within three months postoperatively. Period of hospital stay, post-operative wound infection and time of drain removal had no additive advantage for either groups. 55.6% of the malignant cases underwent hemithyroidectomy and so, second operation was necessary to complete the surgical management while 52.5% of benign cases underwent total thyroidectomy which was considered on overtreatment.
Conclusion: In our study, we concluded that hemithyroid-ectomy was an adequate management option in the majority of the studied cases. TIRADS 5 category of ultrasound assess-ment is the only significant factor that could be relied on to suspect malignancy in a follicular lesion thyroid nodule on FNAC and so total thyroidectomy could be considered in such patients. Hemithyroidectomy was significantly lesser in operative time and pain than total thyroidectomy. In our study, no clinical or demographic data are significant in suspecting malignancy in follicular lesion thyroid nodule. The major challenge in the management of a follicular lesion thyroid nodule remains the assessment as to which nodule requires surgical intervention and which can be followed conservatively. New diagnostic tools are needed to decrease the number of operations performed for benign pathology in patients with a needle biopsy diagnosis of follicular lesion. Finally, the management of follicular lesion thyroid nodule still an area of debate.