Is a hemithyroidectomy as effective as a total thyroidectomy for compressive symptoms?
Reviewed by Christopher Burgess

The claim made in the title of this paper, that hemithyroidectomy is equally as successful as total thyroidectomy in alleviating compressive symptoms from goitres, is certainly intriguing. And with the inclusion of 45,539 subjects, it would at first glance seem that this paper would potentially have robust enough data – at least in terms of numbers – to justify the assertion. Delving into the methodology of the paper does, however, uncover some potential flaws. Firstly, the paper is a retrospective review (rather than a prospective randomised trial) of clinical information held in the TriNetX Research Network database that, in turn, is derived from electronic health records. The prevalence of compressive symptoms (dysphagia and dyspnoea) recorded before and after surgery were compared in patients undergoing a hemithyroidectomy or total thyroidectomy. No significant differences in the frequency of compressive symptoms postoperatively were noted in each group, and compressive symptoms decreased significantly following surgery in both groups. These findings provide the basis for the conclusion that hemithyroidectomies are as effective as total thyroidectomies for compressive symptoms. Clearly, the absence of information about the volume of the goitres treated and the potential asymmetry of the goitre, which may have led to the selection of a hemithyroidectomy over a total thyroidectomy, is a major limitation. Secondly, it would appear that only a minority of the surgeries recorded in the database were performed primarily for compressive symptoms, given that dysphagia and/or dyspnoea were only noted in 8-11% of patients preoperatively. Overall, therefore, the limited quality of the data presented does not justify recommending hemithyroidectomies as the primary treatment option for all compressive goitres. Nevertheless, this paper does appear to confirm that in select cases, a hemithyroidectomy can offer significant benefits in terms of alleviating compressive symptoms, with reduced morbidity compared to a total thyroidectomy.

Management of compression symptoms of thyroid goiters: Hemithyroidectomy is equally as successful as total thyroidectomy.
Moffatt DC, Tucker J, Goldenberg D.
AM J OTOLARYNGOL
2023;44(1):103676.