Diagnostic nodulectomy vs. thyroid lobectomy

In the absence of a cytologic diagnosis of a thyroid nodule, and when clinically indicated to obtain a histopathologic diagnosis, the question arises whether one should perform a nodulectomy or thyroid lobectomy. Even though thyroid lobectomy is the standard of care, at least 25%* of lobectomy patients will require long-term thyroid replacement therapy.

  • Thyroid lobectomy
    • Therapeutic for some differentiated cancers
    • Ipsilateral revision surgery not required
  • Nodulectomy
    • Consider only if patients do not have access to thyroid replacement
    • Nodulectomy ideal for isthmus nodules, or nodules located along the anterior/inferior aspect of the thyroid lobe
    • If nodule situated deeply/posterior in gland, then one should identify the RLN prior to the nodulectomy to avoid injuring the RLN
    • May need to do completion lobectomy depending on histology of nodule, with increased risk to RLN associated with revision surgery

* Ahn D, Sohn JH, Jeon JH. Hypothyroidism Following Hemithyroidectomy: Incidence, Risk Factors, and Clinical Characteristics J Clin Endocrinol Metab. 2016 Apr;101(4):1429-36. https://doi.org/10.1210/jc.2015-3997

* Said M, Chiu V, Haigh PI. Hypothyroidism after hemithyroidectomy. World J Surg. 2013 Dec;37(12):2839-44 https://www.ncbi.nlm.nih.gov/pubmed/23982782

Index: Clinical Practice Guidelines for Thyroid