Optimizing surgical management of thyroid nodules: a prospective study on an individualized approach

Abstract

Introduction. Thyroid nodules are a common condition in medical practice, and the correct selection of patients for surgical treatment is essential in their management. Thyroidectomy is indicated with predilection for nodules suspected of being malignant, with progressive growth or with compressive symptoms. Materials and methods. The study included 89 patients diagnosed with unilateral or bilateral thyroid nodules who met the indications for surgical treatment. All patients underwent preoperative evaluation, including clinical examination, standard laboratory tests, thyroid ultrasonography, hormonal profiling, and fine-needle aspiration in cases with a high suspicion of malignancy. Results. Out of the total number of patients, 2 (2.25%) patients had contraindications to surgery due to cardiac comorbidities associated with high anesthetic-surgical risk. Total thyroidectomy was performed in 41 patients (46.09%), hemithyroidectomy in 44 patients (49.41%), and combined surgeries in 2 cases (2.25%). Postoperative outcomes were favorable in all patients, with no complications registered during the follow-up period. Hormone replacement therapy was administered based on postoperative thyroid hormone levels. Patients who did not undergo surgery were followed up regularly. Conclusions. The extent of thyroidectomy should be tailored to each patient based on the estimated risk of malignancy and the clinical-imaging features of nodules. Total thyroidectomy is recommended in cases with suspected malignancy or bilateral disease, whereas lobectomy may be sufficient for unilateral benign nodules or low malignancy risk.