Thyroid Lobectomy May Offer Comparable Outcomes to Total Thyroidectomy in Selected sMTC

A new study published in the Journal of the American Medical Association revealed that thyroid lobectomy may provide oncologic outcomes comparable to total thyroidectomy in carefully selected patients with sporadic medullary thyroid cancer (sMTC). These findings indicate that less extensive surgery could be a reasonable option for selected patients, though further prospective data are needed to confirm long-term outcomes.

Total thyroidectomy has traditionally been considered the gold standard treatment for both hereditary and sporadic medullary thyroid cancer. The approach aims to minimize recurrence and spread by eliminating all thyroid tissue. However, the new research indicates that thyroid lobectomy, which removes only the affected half of the gland, may be an effective alternative for patients with localized unilateral disease.

This research analyzed data from 9 retrospective studies published through December 2025, which included a total of 1,371 patients diagnosed with sporadic medullary thyroid cancer. Of these, 531 patients underwent lobectomy while 840 received total thyroidectomy. Most tumors included in the analysis were relatively small and confined to the thyroid, with over 80% lacking extrathyroidal extension and more than half showing no lymph node involvement.

Mortality rates at 5 years and beyond were similar regardless of whether patients underwent total thyroidectomy or lobectomy. Overall survival at 5 years was nearly identical between the groups, indicating that removing the entire thyroid did not confer a clear survival advantage in the short to medium term.

Rates of biochemical cure also did not differ significantly at either 5 years or longer follow-up periods. The risk of distant metastasis also appeared to be comparable between the two procedures.

While recurrence rates at 5 years did not differ significantly, total thyroidectomy was associated with lower recurrence beyond 5 years. The analysis showed that complications were more frequent after total thyroidectomy. These complications can range from nerve injury affecting voice function to long-term calcium imbalance due to parathyroid gland disruption, risks that are generally lower with lobectomy.

This review observed that most included studies were retrospective, with varying levels of bias. Only one study was rated as having a low risk of bias, while others were classified as moderate or high risk. Overall, the findings suggest that lobectomy could be a reasonable surgical option for selected patients with small, localized sporadic medullary thyroid cancers.

Reference:

Lincango, E. P., Vilatuna-Andrango, L., Arce-Camposano, A., Mena-García, C., Figueroa, L., Herold, S., Zaldumbide, M., Pacheco, F., Cayambe, J., Solis-Pazmino, P., Westmoreland, T. J., Lew, J. I., Drake, F., Romero-Velez, G., Sosa, J. A., & Brito, J. P. (2026). Total thyroidectomy vs lobectomy for sporadic medullary thyroid cancer: A systematic review and meta-analysis. JAMA Otolaryngology-Head & Neck Surgery. https://doi.org/10.1001/jamaoto.2025.5599