Minimally invasive thyroid nodulectomy reduces post‐operative hypothyroidism when compared with thyroid lobectomy

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Thyroid nodules are common, being detectable by ultrasonography in up to 13–67% of individuals.1 Most do not require treatment; however, for those in whom removal is indicated, a long‐standing surgical tenet is that the minimum procedure for a solitary thyroid nodule, either for diagnosis of a follicular lesion or management of a toxic nodule, is a thyroid lobectomy. Such an approach is designed to minimize the complications of ipsilateral re‐operative surgery should the nodule turn out to be a thyroid cancer. It has been increasingly recognized, however, that hypothyroidism, with the subsequent need for lifelong thyroxine supplementation, is an underappreciated sequela of thyroid lobectomy, with a reported incidence ranging from 8–49%.2 This is in addition to converting an individual, often young, into a medication‐dependent patient for life when, in the majority of cases, the nodule will turn out to have been benign. The occurrence of hypothyroidism following lobectomy has also been shown to effect post‐operative outcome and quality of life.4 Improvements in surgical technology have facilitated significant changes to surgical technique. For example, the introduction of thermal sealing technology, such as LigaSure (Covidien, Mansfield, MA, USA) has enabled minimally invasive thyroid surgery (MITS), with the lateral mini‐incision technique first described by our unit almost a decade ago. MITS, where either nodulectomy or formal lobectomy, is carried out through a 2.5–3‐cm incision, has proved to be both a feasible and safe procedure for the diagnosis of small thyroid nodules with atypical cytology.5 Furthermore, our unit has also demonstrated that MITS nodulectomy provides an attractive alternative to radioiodine ablation for the management of small hyperfunctioning nodules.6 Recent studies have illustrated that increased thyroid remnant volume may be associated with a reduced risk of post‐operative hypothyroidism.7 The aim of this present study was to determine whether MITS nodulectomy has the added advantage of reducing the prevalence of post‐operative hypothyroidism in comparison with formal lobectomy in the surgical management of the solitary thyroid nodule.

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