BACKGROUND
A significant change from prior guidelines was recommendations of lobectomy for patients with cancer limited to one lobe ≤2 cm without extension outside of the thyroid or spread to lymph nodes in the neck. The guidelines also state that a lobectomy could be considered in patients with cancer limited to one lobe >2 and ≤4 cm without extension outside of the thyroid or spread to lymph nodes in the neck. This means more patients will continue to have 1 lobe intact after their initial surgery.

If the diagnosis is confirmed as cancer after a lobectomy, there is always the question of whether the patient needs a 2nd surgery to remove the remaining lobe. This is called completion thyroidectomy. In general, completion thyroidectomy is considered in up to 20% of patients with a lobectomy and cancer >2 and ≤4 cm. This paper summarizes the changes recommendations for a completion thyrodectomy in the 2025 ATA thyroid cancer guidelines.

THE FULL ARTICLE TITLE
Ringel MD et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid 2025;35(8):841-985.

SUMMARY OF THE STUDY
The 2025 ATA thyroid cancer guidelines refer to patients with differentiated thyroid cancer, almost all of which are papillary thyroid carcinoma.

The 2015 guidelines stated that “completion thyroidectomy should be offered to patients for whom a bilateral thyroidectomy would have been recommended had the diagnosis of cancer been available before the initial surgery.” The 2025 guidelines now suggest that completion thyroidectomy is no longer routine. These guidelines state this: “Completion thyroidectomy may be considered to address persistent cancer, to consider radioactive iodine therapy, or to assist follow-up based upon monitoring thyroglobulin levels. The shift that completion thyroidectomy “should be offered” to “may be considered,” reflects less convincing evidence and increasing acceptance of lobectomy as definitive treatment in most low-risk cancers.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The shift to recommend that completion thyroidectomy is no longer routine likely reflects broader cultural movements among both clinicians and patients toward less aggressive treatment of low-risk thyroid cancer. The decision for recommending lobectomy should include a discussion of “Who needs completion?” as well as “Who underwent lobectomy, and why?” As always, the choice of surgery should be a result of a shared decision-making discussion between patients and their doctors.

— Alan P. Farwell, MD

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