title: Total versus hemithyroidectomy for microscopic papillary thyroid cancer.
abstract: BACKGROUND
  No increased mortality has been reported in patients with thyroid papillary microcarcinoma (PMC); however, neck recurrences and distant metastases have been described. In this study, we compare patients' outcomes after total thyroidectomy vs hemithyroidectomy for treatment of thyroid PMC.
  
  
  METHODS
  Two hundred and ninety-three patients from two major medical centers in Israel were included. The mean follow-up period was 7.2±6.8 yr.
  
  
  RESULTS
  Total thyroidectomy was performed in 214 patients and hemithyroidectomy in 79 patients. Mean tumor size was 6.3±3 mm. Lymph-node (LN) metastases and extraglandular extension were more frequent in the total thyroidectomy group than in the hemithyroidectomy group, 24.8% vs 1.3% (p<0.001) and 11.7% vs 3.8% (p=0.042), respectively. The cumulative incidence of recurrence at the end of follow-up was 13.2% in the total thyroidectomy group and 14.3% in the hemithyroidectomy group (p=ns). The incidence of recurrence was higher in patients with LN involvement in both groups. Considering low risk patients only (monofocal tumors, no LN involvement, no extraglandular extension; no.=63 in the total thyroidectomy group vs no.=60 in the hemithyroidectomy group) neck recurrence was found in 10% of patients in the hemithyroidectomy group but none in the total thyroidectomy group. In the hemithyroidectomy group, all locoregional recurrences were diagnosed using ultrasonography, compared to 47.6% in the total thyroidectomy group.
  
  
  CONCLUSIONS
  For patients with monofocal disease within the thyroid gland and no LN involvement, hemithyroidectomy can be considered an option, bearing in mind a higher risk for recurrence. For all other patients with PMC, we propose total thyroidectomy as initial treatment.
authors.affiliation: Department of Endocrinology, Linn Medical Center, General Health Services, 35 Rotchild st. Haifa, 35152, Israel. gershinsky@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Gershinsky
authors.forename: O
authors.initials: O
authors.lastname: Barnett-Griness
authors.forename: N
authors.initials: N
authors.lastname: Stein
authors.forename: D
authors.initials: D
authors.lastname: Hirsch
authors.forename: G
authors.initials: G
authors.lastname: Tzvetov
authors.forename: O
authors.initials: O
authors.lastname: Bardicef
authors.forename: J
authors.initials: J
authors.lastname: Pauker
authors.forename: S
authors.initials: S
authors.lastname: Grozinsky-Glasberg
authors.forename: S
authors.initials: S
authors.lastname: Ish-Shalom
authors.forename: I
authors.initials: I
authors.lastname: Slutski
authors.forename: I
authors.initials: I
authors.lastname: Shimon
authors.forename: C
authors.initials: C
authors.lastname: Benbassat
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult