Lobectomy Versus Total Thyroidectomy in Suspicious or Malignant Thyroid Nodules

  • Jennifer S. MammenEmail author
  • David S. Cooper


Differentiated thyroid cancer frequently has an excellent prognosis, with very low risk of recurrence after adequate surgery. A growing body of evidence demonstrates no benefit from radioactive iodine or extensive surgery in these low-risk patients and suggests that many individuals will be well treated with less than total thyroidectomy. Determining the best initial surgery to minimize complications but also avoid reoperation is a critical goal of the preoperative assessment. Accurate assessment is particularly valuable with transoral surgery, where conversion to open procedures for unexpected intraoperative findings and reoperation both present challenges. Ultrasound findings and patient characteristics are variably helpful in predicting postoperative risk status. The development of strategies to determine the best surgical approach in individual patients has been a main focus of the American Thyroid Association guidelines, which now recommend lobectomy be considered for solitary nodules up to 4 cm without evidence of extrathyroidal extension on ultrasound. The cost-effectiveness of this or other paradigms for predicting risk remains an active area of research.


Differentiated thyroid cancer Lobectomy Total thyroidectomy Recurrence Low risk Ultrasound Pathology Age Cancer staging Cost-effectiveness 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Endocrinology, Diabetes and MetabolismThe Johns Hopkins School of MedicineBaltimoreUSA

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