Natural History of Contralateral Nodules After Lobectomy in Patients With Papillary Thyroid Carcinoma

J Clin Endocrinol Metab. 2018 Feb 1;103(2):407-414. doi: 10.1210/jc.2017-01616.


Background: Bilateral thyroid nodularity is considered an indication for total thyroidectomy in papillary thyroid carcinoma (PTC). However, the natural history and outcome of contralateral nodules have never been studied.

Objective: To investigate the natural history of nonsuspicious contralateral nodules after lobectomy for PTC.

Methods: We included patients who had one or more solid nodules (≥3 mm) in the contralateral lobe with benign cytology before surgery or small nonsuspicious nodules per ultrasonography.

Results: One hundred and twelve patients were included. Median age was 57 years, and median size of the PTC (initial lobectomy) was 8 mm (range, 0.5 to 28 mm). On the contralateral side, the median size of nodules was 7 mm (range, 3 to 30 mm). Thirty-three nodules (29%) had fine-needle aspiration (FNA) before surgery, and all were benign. After a median follow-up of 6 years, median growth was zero (range, -20 to 19 mm). Twenty-six nodules (23%) increased ≥3 mm in size (median, 6 mm; range, 4 to 19 mm). Twenty patients (18%) developed new nodules. Twelve patients (11%) underwent completion thyroidectomy for growth (three), suspicious FNA (seven; Bethesda III to V), malignancy (one), or unknown reason (one). Overall, according to the completion thyroidectomy specimen, six patients (5%) were diagnosed with contralateral PTC (five micro-PTCs, one 20 mm), and all were without evidence of disease at the end of follow-up. There were no surgical difficulties or local complications during completion surgery.

Conclusions: Lobectomy for low-risk patients with a small PTC and nonsuspicious contralateral thyroid nodule(s) is a reliable and safe initial treatment option. In the few patients who required completion thyroidectomy, treatment with surgery and radioiodine was effective.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Papillary / complications*
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery*
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Thyroid Cancer, Papillary
  • Thyroid Neoplasms / complications*
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery*
  • Thyroid Nodule / complications*
  • Thyroid Nodule / diagnosis
  • Thyroid Nodule / pathology*
  • Thyroidectomy / methods*
  • Ultrasonography