Hemithyroidectomy, as opposed to total thyroidectomy with radioiodine remnant ablation, is now increasingly undertaken for low-risk, differentiated thyroid cancer. If on histology, this proves ‘high risk’, completion thyroidectomy is done fairly soon. In this retrospective study, a total of 105 patients were analysed, of which 74 underwent primary completion surgery (Group A). In group B, 31 patients underwent only hemithyroidectomy because they were classified as low risk according to the American Thyroid Association system. They had postoperative ultrasound surveillance. In Group A, 26/74 patients had at least one malignant nodule in the subsequently excised contralateral lobe. Preoperative ultrasound in these patients did not show any findings of concern, suggesting that papillary microcarcinoma can be sonographically occult. The study focuses on Group B in terms of the ultrasound follow-up findings to assess the actual value of this surveillance. Only three of the 31 patients who underwent only hemithyroidectomy, had ultrasound and FNA findings of interest, namely a U3 nodule proving to be microcarcinoma which required no further treatment, a benign adenoma and a hypoechoeic lesion. A few studies with similar results have been mentioned, also stating that post-treatment surveillance ultrasound is associated with a high false-positive rate. There is also a high relative financial cost in the surveillance of the low-risk group and it is associated with patients reporting ongoing concerns amounting to a negative effect on the health-related quality of life. There is, therefore, little evidence in support of ongoing ultrasound surveillance for malignancy in low-risk patients requiring only hemithyroidectomy.
Postoperative ultrasound surveillance in patients undergoing hemithyroidectomy
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