European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
Is hemithyroidectomy enough? Low risk of occult contralateral disease in sporadic medullary thyroid cancer.
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Spörlein Andreas, Becker Christoph, Berthelot Joseph, Burkhardt Valentin, Laubner Katharina, Fink Mira, Jänigen Bernd
Аннотация
PURPOSE: Total thyroidectomy (TT) remains the standard surgical treatment of sporadic medullary thyroid cancer (sMTC), primarily due to the presumed risk of occult contralateral disease. However, recent evidence suggests that in selected patients, hemithyroidectomy (HT) may offer comparable oncologic outcomes. This retrospective study aimed to evaluate the prevalence of occult contralateral disease and to identify clinicopathological factors associated with disease-free survival (DFS).
METHODS: We retrospectively analyzed all surgical patients with sMTC at a tertiary academic center (2013-2025), excluding patients with hereditary MTC, RET mutations, or clinical evidence of MEN2. Kaplan-Meier analysis with logrank testing was used to identify predictors of DFS.
RESULTS: Forty-eight patients were included (66.7% female, median age 60.5 years). TT was performed in 44 patients (91.7%). Bilateral disease was present in five patients (11.4%), all detected on preoperative ultrasound. No cases of occult contralateral disease were found. During a median follow-up of 3.4 years, seven patients (14.6%) experienced recurrence. Advanced T stage, nodal involvement, distant metastases, lymphatic and vascular invasion, extracapsular extension, and male sex were all significantly associated with reduced DFS (all p < 0.05). Persistent postoperative calcitonin elevation (> 2 pg/mL) strongly predicted recurrence (p < 0.001), whereas baseline calcitonin > 500 pg/mL did not.
CONCLUSION: Occult contralateral disease in sMTC is rare when high-quality preoperative ultrasound is available. In selected patients with unifocal, node-negative tumors and favorable pathology, HT combined with structured calcitonin monitoring may be an oncologically safe, less morbid alternative. These findings support individualized, risk-adapted surgical strategies in sMTC. Prospective validation is warranted.
METHODS: We retrospectively analyzed all surgical patients with sMTC at a tertiary academic center (2013-2025), excluding patients with hereditary MTC, RET mutations, or clinical evidence of MEN2. Kaplan-Meier analysis with logrank testing was used to identify predictors of DFS.
RESULTS: Forty-eight patients were included (66.7% female, median age 60.5 years). TT was performed in 44 patients (91.7%). Bilateral disease was present in five patients (11.4%), all detected on preoperative ultrasound. No cases of occult contralateral disease were found. During a median follow-up of 3.4 years, seven patients (14.6%) experienced recurrence. Advanced T stage, nodal involvement, distant metastases, lymphatic and vascular invasion, extracapsular extension, and male sex were all significantly associated with reduced DFS (all p < 0.05). Persistent postoperative calcitonin elevation (> 2 pg/mL) strongly predicted recurrence (p < 0.001), whereas baseline calcitonin > 500 pg/mL did not.
CONCLUSION: Occult contralateral disease in sMTC is rare when high-quality preoperative ultrasound is available. In selected patients with unifocal, node-negative tumors and favorable pathology, HT combined with structured calcitonin monitoring may be an oncologically safe, less morbid alternative. These findings support individualized, risk-adapted surgical strategies in sMTC. Prospective validation is warranted.