Diagnostic evaluation, risk stratification, and peri-surgical management strategies in thyroid disorders.

OBJECTIVE

Aim: To discuss the indications for elective thyroid surgery and peri-surgical clinical strategy in patients with thyroid diseases.

PATIENTS AND

METHODS

Materials and

Methods

A comprehensive literature review was conducted from October 2024 to April 2025, analyzing relevant publications published between June 2005 and January 2024, sourced from PubMed, Scopus, Web of Science, and the Cochrane Library. Thyroid disorders encompass various conditions, including Graves' disease, hyperthyroidism, and thyrotoxicosis. Hypothyroidism manifests as subclinical or overt. Surgical indications for thyroidectomy include symptomatic nodules, indeterminate/Bethesda III-V cytology, malignancy (Bethesda VI), or compressive symptoms. Ultrasound-guided Fine-Needle Aspiration (FNA), based on nodule size and EU-TIRADS risk stratification, is pivotal for evaluation. Advanced aids in risk assessment. Surgical complications (hemorrhage, hypoparathyroidism, recurrence laryngeal nerve injury) require prompt management. Molecular testing refines indeterminate cytology diagnoses. Thyroidectomy is contraindicated in anaplastic cancer and/or high surgical risk cases. Postoperative monitoring for hypocalcemia, voice changes, and bleeding is essential.

CONCLUSION

Conclusions

Resource constraints hinder widespread adoption of advanced thyroid diagnostics, creating challenges in optimal nodule management.