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Background <p>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.</p> Objective <p>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.</p> Methods <p>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.</p> Results <p>After propensity score matching, 400 patients were included in each group (median follow-up 7.2&#xa0;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, <i>p</i> = 0.43). The 8-year recurrence-free survival rates were 96.8% versus 94.2% (HR 1.48, 95% CI 0.73–2.98, <i>p</i> = 0.28). Hemithyroidectomy was associated with a significantly lower rate of permanent hypoparathyroidism (2.0% vs 8.0%, <i>p</i> &lt; 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%, <i>p</i> = 0.018). Mean total 8-year healthcare costs were lower with hemithyroidectomy (¥28,247 vs ¥55,439, <i>p</i> &lt; 0.001).</p> Conclusions <p>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.</p>

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

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  • 发表日期：

    2026年7月23日

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

摘要

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.