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Cancers
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New Insights into Thyroid Cancer Surgery
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New Insights into Thyroid Cancer Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 July 2025 | Viewed by 7303

Special Issue Editors

Dr. Maurizio Iacobone

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Guest Editor
Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
Interests: endocrine surgery; thyroid surgery; adrenal surgery; parathyroid surgery; hereditary endocrine tumors; minimally invasive surgery
Dr. Francesca Torresan

E-Mail Website
Guest Editor
Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
Interests: endocrine surgery; thyroid surgery; adrenal surgery; parathyroid surgery; hereditary endocrine tumors; minimally invasive surgery

Special Issue Information

Dear Colleagues,

Thyroid cancer is the most common endocrine malignancy, with an increased incidence in last years. Even if active surveillance and minimally invasive interventions have been proposed for low-risk differentiated thyroid cancer (DTC), surgery remains the mainstay of treatment for patients with a suspected or cytologically confirmed DTC; however, controversy over the most appropriate extent of thyroid resection (lobectomy vs. total thyroidectomy) remains. In fact, the risk of recurrent laryngeal nerve palsy is higher in total thyroidectomy compared to lobectomy, as are the risk of hypoparathyroidism and the need for thyroid hormone replacement. Another controversial issue in thyroid cancer surgery is the management of central lymph node dissection; even if central lymph node dissection is required for clinically evident lymph node metastasis, the role of prophylactic lymph node dissection is still debated. Moreover, although total thyroidectomy with bilateral central lymph node dissection is mandatory in patients with medullary thyroid carcinoma, the extent of lymph node dissection in the lateral compartment remains controversial. 

The use of even more precise surgical devices and new technology allows safer surgery, simplifying the preservation of nerves, blood vessels, and parathyroid glands. On this issue, intraoperative neuromonitoring has facilitated the early identification of recurrent laryngeal nerve injuries, and intraoperative parathyroid autofluorescence as well as indocyanine green angiography were carried out to visualize and preserve parathyroid gland function.

In light of such a new scenario, the aim of this Special Issue of Cancers is to analyze the previously described various issues in thyroid cancer surgery to offer new perspectives, promote innovative approaches, and provide a comprehensive overview of the current developments in thyroid cancer surgery. For this purpose, we welcome original research articles or comprehensive review articles that will provide a critical analysis of these issues to further increase our knowledge of thyroid cancer.

Dr. Maurizio Iacobone
Dr. Francesca Torresan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • total thyroidectomy
  • differentiated thyroid cancer
  • lymph node dissection
  • parathyroid autofluorescence
  • medullary thyroid carcinoma
  • recurrent laryngeal nerve neuromonitoring

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Published Papers (5 papers)

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Research

13 pages, 1252 KiB  
Article
Beyond the Burn: Leukemia Threats Following Radioactive Iodine Ablation Therapy for Thyroid Cancer
by Mohammad H. Hussein, Eman Toraih, Jessan A. Jishu, Tessa Lavorgna, Ahmed Abdelmaksoud, Ryan Craig and Emad Kandil
Cancers 2025, 17(1), 25; https://doi.org/10.3390/cancers17010025 - 25 Dec 2024
Viewed by 1133
Abstract
Background: Radioactive iodine (RAI) ablation therapy is a common minimally invasive treatment for patients diagnosed with differentiated thyroid cancer (DTC). Although previous studies have identified a link between RAI and the mortality from secondary solid cancers, the connection between RAI and leukemia remains [...] Read more.
Background: Radioactive iodine (RAI) ablation therapy is a common minimally invasive treatment for patients diagnosed with differentiated thyroid cancer (DTC). Although previous studies have identified a link between RAI and the mortality from secondary solid cancers, the connection between RAI and leukemia remains under-researched. This study investigated the differential risk of leukemia and its subtypes in DTC patients following RAI treatment. Methods: DTC patients from the Surveillance, Epidemiology, and End Results (SEER) Registry 17 (2000–2019) were analyzed. The standard incidence ratio (SIR) and excess risk (ER) compared to the reference population were calculated. Results: Out of 196,569 DTC patients, 1381 patients developed various types of hematological malignancies. Leukemia was diagnosed in 508 of these patients, and it had the highest risk among the malignancies studied, with an SIR of 1.74 (95%CI: 1.59–1.9). The RAI group had an SIR of 2.12 (95%CI: 1.87–2.39), while the non-RAI group had an SIR was 1.45 (95%CI: 1.37–1.52) (p < 0.001). Those diagnosed before the age of 55 years had a conspicuously elevated risk (SIR 2.74) compared to those diagnosed at 55 years or older (SIR 1.53). American Indian/Alaska Native survivors manifested a pronounced leukemia risk with an SIR of 7.63 (95%CI: 2.46–17.8). Conclusions: RAI treatment increased the risk of developing leukemia when serving as adjuvant therapy in surgical patients (SIR 2.12). There exists a significant association between RAI treatment in DTC patients and the incidence of leukemia. This susceptibility seems to be modulated by factors including time since diagnosis, age, gender, and racial background. Full article
(This article belongs to the Special Issue New Insights into Thyroid Cancer Surgery)
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12 pages, 499 KiB  
Article
Predictive Factors of Athyroglobulinemia After Total Thyroidectomy for Papillary Thyroid Cancer
by Marta Fernández-Baeza, Nuria V. Muñoz-Pérez, Ignacio Roldán-Ortiz, María J. Alonso-Sebastián, Francisco M. Carbajo-Barbosa, Rafael Rejón-López, María C. Olvera-Porcel, Antonio Becerra-Massare, Juan I. Arcelus-Martínez and Jesús María Villar-del-Moral
Cancers 2024, 16(24), 4129; https://doi.org/10.3390/cancers16244129 - 11 Dec 2024
Viewed by 934
Abstract
Background: Thyroglobulin (Tg) is the specific tumor marker for epithelial thyroid cancer. It holds significant value in the postoperative period, and somehow, the goal of surgery in papillary thyroid cancer (PTC) undergoing total thyroidectomy is to achieve undetectable levels of postoperative thyroglobulin [...] Read more.
Background: Thyroglobulin (Tg) is the specific tumor marker for epithelial thyroid cancer. It holds significant value in the postoperative period, and somehow, the goal of surgery in papillary thyroid cancer (PTC) undergoing total thyroidectomy is to achieve undetectable levels of postoperative thyroglobulin (uTg). Methods: This is a retrospective single-center study in which first basal Tg values were evaluated post-surgery in PTC patients undergoing total thyroidectomy. Patients with elevated antithyroglobulin antibodies were excluded. The impact of various demographic, clinical, therapeutic, tumor-stage related, and histopathological variables on the achievement of undetectable thyroglobulin levels (uTg, <1 ng/mL) was studied. A descriptive and logistic regression-based bivariate and multivariate analysis was planned using STATA vs. 16.1. program. The significance level was stated at 0.05. Results: Basal athyroglobulinemia was obtained in 89.6% of 202 patients operated on between January 2015 and June 2023 in a single referral institution. Due to the limited number of cases with detectable Tg, multivariate analysis could not be performed. The main factors that favored its achievement on bivariate analysis were a smaller tumor size (p = 0.003), no need for extended resections due to local invasion beyond the thyroid gland (p = 0.003) or neck dissection (p = 0.039), absence of distant metastases (p = 0.000), and a lower MACIS score (p < 0.000). Conclusions: The achievement of uTg was closely related to factors related to tumor stage (tumor diameter, lymph node spread, and metastatic disease), and it was not influenced by differences in epidemiological data, clinic manifestations, preoperative diagnosis, multifocality, or the presence of aggressive cytological variants. Full article
(This article belongs to the Special Issue New Insights into Thyroid Cancer Surgery)
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Figure 1

22 pages, 2940 KiB  
Article
Limited Thyroidectomy Achieves Equivalent Survival to Total Thyroidectomy for Early Localized Medullary Thyroid Cancer
by Jessan A. Jishu, Mohammad H. Hussein, Salman Sadakkadulla, Solomon Baah, Yaser Y. Bashumeel, Eman Toraih and Emad Kandil
Cancers 2024, 16(23), 4062; https://doi.org/10.3390/cancers16234062 - 4 Dec 2024
Cited by 2 | Viewed by 1059
Abstract
Background: The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but lobectomy and subtotal thyroidectomy may minimize mortality while maintaining oncologic control. Methods: This retrospective analysis utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results [...] Read more.
Background: The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but lobectomy and subtotal thyroidectomy may minimize mortality while maintaining oncologic control. Methods: This retrospective analysis utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry to identify 2702 MTC patients including 398 patients with T1N0/1M0 MTC treated with total thyroidectomy or lobectomy/subtotal thyroidectomy from 2000 to 2019. Cox regression analyses assessed thyroid cancer-specific and overall mortality. Results: The majority (89.7%) underwent total thyroidectomy, while 10.3% had lobectomy/subtotal thyroidectomy. Nodal metastases were present in 29.6%. Over a median follow-up of 8.75 years, no significant difference was observed in cancer-specific mortality (5.7% vs. 8.1%, p = 0.47) or overall mortality (13.2% vs. 12.8%, p = 0.95). On multivariate analysis, undergoing cancer-directed surgery was associated with significantly improved overall survival (HR 0.18, p < 0.001) and cancer-specific survival (HR 0.17, p < 0.001) compared to no surgery. However, no significant survival difference was seen between total thyroidectomy and lobectomy/subtotal thyroidectomy for overall mortality (HR 0.77, p = 0.60) or cancer-specific mortality (HR 0.44, p = 0.23). The extent of surgery also did not impact outcomes within subgroups stratified by age, gender, T stage, or nodal status. Delayed surgery >1 month after diagnosis was associated with worse overall survival (p = 0.012). Conclusions: For localized T1 MTC, lobectomy/subtotal thyroidectomy appears to achieve comparable long-term survival to total thyroidectomy in this population-based analysis. The selective use of limited thyroidectomy may be reasonable for low-risk T1N0/1M0 MTC patients. Delayed surgery is associated with worse survival and additional neck dissection showed no benefit for this select group of patients. Full article
(This article belongs to the Special Issue New Insights into Thyroid Cancer Surgery)
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13 pages, 1288 KiB  
Article
Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients
by Silvia Dughiero, Francesca Torresan, Simona Censi, Caterina Mian, José Luis Carrillo Lizarazo and Maurizio Iacobone
Cancers 2024, 16(16), 2867; https://doi.org/10.3390/cancers16162867 - 17 Aug 2024
Cited by 1 | Viewed by 1525
Abstract
Background: Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce. Methods: The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level [...] Read more.
Background: Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce. Methods: The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery. Results: Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559; p < 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563; p < 0.001). Conclusions: Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH. Full article
(This article belongs to the Special Issue New Insights into Thyroid Cancer Surgery)
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17 pages, 1041 KiB  
Article
Initial versus Staged Thyroidectomy for Differentiated Thyroid Cancer: A Retrospective Multi-Dimensional Cohort Analysis of Effectiveness and Safety
by Eman A. Toraih, Mohammad H. Hussein, Jessan A. Jishu, Madeleine B. Landau, Ahmed Abdelmaksoud, Yaser Y. Bashumeel, Mahmoud A. AbdAlnaeem, Rithvik Vutukuri, Christine Robbie, Chelsea Matzko, Joshua Linhuber, Mohamed Shama, Salem I. Noureldine and Emad Kandil
Cancers 2024, 16(12), 2250; https://doi.org/10.3390/cancers16122250 - 18 Jun 2024
Viewed by 1886
Abstract
The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify [...] Read more.
The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify the optimal timing for completion thyroidectomy using a multi-dimensional analysis of four cohorts: an institutional series (n = 148), the National Surgical Quality Improvement Program (NSQIP) database (n = 39,992), the TriNetX repository (n > 30,000), and a pooled literature review (10 studies, n = 6015). Institutional data revealed higher overall complication rates with total thyroidectomy (18.3%) compared to completion thyroidectomy (6.8%), primarily due to increased temporary hypocalcemia (10% vs. 0%, p = 0.004). The NSQIP analysis demonstrated that total thyroidectomy was associated with a 72% increased risk of transient hypocalcemia (p < 0.001) and a 25% increased risk of permanent hypocalcemia (p < 0.001). TriNetX data confirmed these findings and identified obesity and concurrent neck dissection as risk factors for complications. A meta-analysis showed that total thyroidectomy increased the rates of transient (RR = 1.63) and permanent (RR = 1.23) hypocalcemia (p < 0.001). Institutional and TriNetX data suggested that performing completion thyroidectomy between 1 and 6 months after the initial lobectomy minimized permanent complication rates compared to delays beyond 6 months. In conclusion, for differentiated thyroid cancer, total thyroidectomy is associated with higher risks of transient and permanent hypocalcemia compared to staged completion thyroidectomy. However, performing completion thyroidectomy within 1–6 months of the initial lobectomy may mitigate the risk of permanent complications. These findings can inform personalized surgical decision-making for patients with differentiated thyroid cancer. Full article
(This article belongs to the Special Issue New Insights into Thyroid Cancer Surgery)
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