Comparative effectiveness of total thyroidectomy versus hemithyroidectomy for low-risk differentiated thyroid cancer: a multicenter retrospective cohort study with propensity score matching.
6 affiliations
- 1Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, Selangor Darul Ehsan, 47500, Malaysia.
- 2Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, Selangor Darul Ehsan, 47500, Malaysia. [email protected].
- 3Department of Thyroid Surgery, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, China.
- 4Department of Thyroid Surgery, the Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, China.
- 5Shanghai Hospital of Traditional Chinese Medicine, Shanghai, 200000, China.
- 6Chongqing Branch of Jiangsu Provincial Hospital of Traditional Chinese Medicine, Chongqing, 404000, China.
Abstract
Background
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.Objective
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.Methods
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.Results
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).Conclusions
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.
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BibTeX
@article{ma2026comparative,
title = {{Comparative effectiveness of total thyroidectomy versus hemithyroidectomy for low-risk differentiated thyroid cancer: a multicenter retrospective cohort study with propensity score matching.}},
author = {Zhen Ma and Ihab E Ali and Vivian George Vincent Fernandez and Wei Wang and Jinqiang Pan and Jingliang Gu and Ziyi Zhai},
journal = {BMC surgery},
year = {2026},
month = jul,
doi = {10.1186/s12893-026-04028-2},
url = {https://europepmc.org/article/MED/42894139},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparative effectiveness of total thyroidectomy versus hemithyroidectomy for low-risk differentiated thyroid cancer: a multicenter retrospective cohort study with propensity score matching.
AU - Zhen Ma
AU - Ihab E Ali
AU - Vivian George Vincent Fernandez
AU - Wei Wang
AU - Jinqiang Pan
AU - Jingliang Gu
AU - Ziyi Zhai
PY - 2026
DA - 2026/07/01
JO - BMC surgery
DO - 10.1186/s12893-026-04028-2
UR - https://europepmc.org/article/MED/42894139
AB - Background 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.Objective 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.Methods 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.Results 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).Conclusions 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.
SN - 1471-2482
ER -