High rate of recurrence after lobectomy for solitary thyroid nodule

Objective: To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule. Design: Retrospective study. Setting: University hospital, Patients: 83 patients admitted with a clinical diagnosis of solitary thyroid nodule. Interventions: Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy. Main outcome measures: Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity. Results: One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy. 6 had an adenoma and IS had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%. and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%, p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma. and all the other recurrences occurred in patient,. with nodular hyperplasia, Conclusions: The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence.