BACKGROUND
Thyroid cancer is common. Fortunately, thyroid cancer has an excellent prognosis. Surgery to remove the thyroid is usually the initial treatment. Historically, the entire thyroid was removed (total thyroidectomy). Currently, removing the half of the thyroid that contains the cancer (lobectomy) has become more common as guidelines and practices of physicians are considering less invasive treatments for thyroid cancer. Indeed, recent guidelines from the American Thyroid Association (ATA) recommend basing the decision of total thyroidectomy vs lobectomy on the rick of the cancer recurring after initial treatment.

Most patients who have thyroid cancer that has spread to the lymph nodes are considered intermediate- high or high risk of recurrence, according to the ATA guidelines. These patients are usually treated with a total thyroidectomy, lymph node removal, and radioactive iodine therapy to destroy all remaining thyroid cells after surgery. Less aggressive treatment options would include having a lobectomy, or half the thyroid gland surgically removed, and not receiving radioactive iodine therapy.

The goal of this study is to see if patients who had the previous, more aggressive treatments for their thyroid cancer do as well in the first 5 years after treatment as those patients who received less aggressive treatments.

THE FULL ARTICLE TITLE
Scholfield DW, et al. Thyroid lobectomy and neck dissection for N1b papillary thyroid carcinoma. JAMA Otolaryngol Head Neck Surg 2026;152(2):208–214; doi: 10.1001/jamaoto.2025.4653. PMID: 41411004.

SUMMARY OF THE STUDY
Patients from a single hospital were studied for 34 years. After the thyroid cancer treatments, patients whose thyroid cancer had spread to the lymph nodes who had a total thyroidectomy and radioactive iodine therapy were compared to patients who just had a surgical lobectomy and lymph node removal. Over 7-9 years, the overall survival at 5 years, the survival affected by the cancer, and 5-year chance of not having a thyroid cancer recurrence were compared.

The smaller group of 37 patients had a lobectomy with a lymph node dissection surgery with no radioactive iodine. The larger group of patients had a total thyroidectomy, lymph node dissection (with a similar number of lymph nodes removed as the smaller group), as well as radioactive iodine therapy. The two groups had similar overall survivals at 5 years at 96.9% in the smaller group and 96.8% in the larger group, similar survivals affected by the cancer at 5 years of 96.7% in the smaller group and 100% in the larger group, and a similar chance of not having a thyroid cancer recurrence at 5 years of 89.8% in the smaller group and 88.9% in the larger group. In fact, these result trends also held true when patients were analyzed at 10 years after treatment as well.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that patients who are at ATA intermediate-high risk and had a lobectomy and lymph nodes removed had similar 5-year survivals and 5-year chances of not having a thyroid cancer recurrence as those patients who had their whole thyroid gland removed, lymph nodes removed, and radioactive iodine therapy. These data suggest that some patients who have thyroid cancer that has spread to the lymph nodes can be treated less aggressive therapy. It is encouraging that these less aggressive treatments still have good outcomes for certain thyroid cancer patients. More studies are needed to confirm these results.

— Pinar Smith, MD

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