Robenshtok, Eyal2,3, Ritter, Amit1,2; Bachar, Gideon1,2; Hirsch, Dania2,3; Benbassat, Carlos2,4; Katz, Orna1,2; Kochen, Nadav1,2
1 Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Israel
2 Sackler School of Medicine, Tel-Aviv University, Israel
3 Endocrine Institute, Rabin Medical Center, Israel
4 Endocrine Unit, Assaf Harofeh Medical Center, Israel
Background: Bilateral thyroid nodularity is considered an indication for total thyroidectomy in PTC patients. However, the natural history and outcome of contralateral nodules has never been studied.
Objective: To investigate the natural history of non-suspicious contralateral nodules after lobectomy for PTC.
Methods: We included patients who had ?1 nodules (?3mm) in the contralateral lobe prior to surgery that was benign on cytology, or small and not suspicious per ultrasound.
Results: One hundred and eighteen patients were included in the study, operated between 1/2002-12/2013. Median age was 57 years, and median size of PTC (lobectomy specimen) was 8mm (range 0.5-40). Median size of contralateral nodules was 7mm (range 3-30). Thirty-four nodules (29%) had FNA before surgery, and none was suspicious. After median follow-up of 6 years, 29 nodules (25%) increased in size ?3mm, with median growth of 6mm (range 4-19). Twenty-two patients (19%) developed new nodules. Fifteen patients (13%) underwent completion thyroidectomy for growth (3), suspected malignancy on FNA (9 with Bethesda III-V), or malignancy (3). Overall, based on the completion thyroidectomy specimen, 8 patients (7%) were diagnosed with contralateral PTC (5 microPTC, one 20mm), and are all without evidence of disease at the end of follow-up. There were no surgical difficulties or local complications during completion surgery.
Conclusions: Lobectomy in patients with PTC and contralateral non-suspicious thyroid nodule/s is safe, but requires regular ultrasound follow-up as growth is seen in 25% of patients. In the few patients who required completion thyroidectomy, treatment with surgery and radioiodine was effective.