Comparative effectiveness of total thyroidectomy versus hemithyroidectomy for low-risk differentiated thyroid cancer: a multicenter retrospective cohort study with propensity score matching.

Authors

Zhen Ma, Ihab E Ali, Vivian George Vincent Fernandez, Wei Wang, Jinqiang Pan, Jingliang Gu, Ziyi Zhai

Published in

BMC surgery. Volume 26. Issue 1. Jul 23, 2026. Epub Jul 23, 2026.

Abstract

The optimal surgical approach for patients with low-risk differentiated thyroid cancer (DTC) remains controversial. Current evidence comparing long-term outcomes between total thyroidectomy and hemithyroidectomy is limited by short follow-up and a lack of comprehensive patient-reported outcomes.
To compare the effectiveness of total thyroidectomy versus hemithyroidectomy in patients with low-risk DTC, evaluating oncologic outcomes, complications, thyroid function, quality of life, and healthcare costs.
We conducted a multicenter retrospective cohort study of 800 patients with low-risk DTC treated at three tertiary centers between 2014 and 2021, with follow-up through 2023. Propensity score matching (1:1) was performed using age, sex, tumor size, histology, and BRAF V600E status. Patients were analyzed according to the operation actually performed (as-treated analysis). Primary outcomes were overall survival and recurrence-free survival. Secondary outcomes included complications, thyroid function, quality of life (HADS, SCL-90), and healthcare costs. Analyses included Kaplan-Meier survival analysis with log-rank tests and Cox proportional-hazards regression, with Bonferroni correction for the two primary endpoints.
After propensity score matching, 400 patients were included in each group (median follow-up 7.2 years, IQR 5.1-8.9). The 8-year overall survival rates were 97.2% (95% CI 95.6-98.8%) for total thyroidectomy versus 96.1% (95% CI 94.2-97.9%) for hemithyroidectomy (HR 0.79, 95% CI 0.44-1.42, p = 0.43). The 8-year recurrence-free survival rates were 96.8% versus 94.2% (HR 1.48, 95% CI 0.73-2.98, p = 0.28). Hemithyroidectomy was associated with a significantly lower rate of permanent hypoparathyroidism (2.0% vs 8.0%, p < 0.001, NNH = 17). Total thyroidectomy entailed a universal requirement for lifelong levothyroxine (100% vs 15% requiring replacement in the hemithyroidectomy group); among hemithyroidectomy patients not requiring replacement, subclinical hypothyroidism was common. At one year, fewer hemithyroidectomy patients reported clinically significant anxiety/depression (18% vs 25%, p = 0.018). Mean total 8-year healthcare costs were lower with hemithyroidectomy (¥28,247 vs ¥55,439, p < 0.001).
For appropriately selected patients with low-risk DTC, hemithyroidectomy provides oncologic outcomes comparable to total thyroidectomy while offering advantages in complications, thyroid-function preservation, quality of life, and healthcare costs. Treatment decisions should be individualized through shared decision-making. These findings support consideration of de-escalated surgery but require validation in prospective randomized trials.

PMID:
42894139
Bibliographic data and abstract were imported from PubMed on 19 Oct 2026.

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