Risk-Benefit Assessment of Total Thyroidectomy versus Hemithyroidectomy in the Management of Benign Thyroid Nodules

Background: The optimal surgical approach for benign thyroid nodules remainscontroversial. This study aimed to compare the outcomes of total thyroidectomy versushemithyroidectomy for benign thyroid nodules to inform clinical decision-making.Methods: A prospective observational study was conducted on 70 patients (32 totalthyroidectomy, 38 hemithyroidectomy) with benign thyroid nodules who underwentsurgery between January and December 2024. Outcomes assessed includedperioperative parameters, complications, functional outcomes, quality of life, andrecurrence rates.Results: The total thyroidectomy group had significantly larger nodules (3.8±1.2 vs.3.2±0.9 cm, p=0.022) and higher prevalence of multinodular goiter (75.0% vs. 44.7%,p=0.011). Total thyroidectomy was associated with longer operative time (128.4±31.2vs. 89.6±24.5 minutes, p<0.001), greater blood loss (78.5±36.2 vs. 52.3±28.7 mL,p=0.001), and extended hospital stay (3.2±0.9 vs. 2.1±0.8 days, p<0.001).Complication rates were significantly higher in the total thyroidectomy group (43.8%vs. 15.8%, p=0.009), primarily due to transient hypoparathyroidism (28.1% vs. 0%,p<0.001). All total thyroidectomy patients required levothyroxine compared to 18.4%in the hemithyroidectomy group (p<0.001). Quality of life assessment showed betteroverall scores in the hemithyroidectomy group (20.5±14.2 vs. 28.4±16.8, p=0.033).Among hemithyroidectomy patients, 18.4% developed new nodules and 5.3% requiredcompletion thyroidectomy within 12 months.Conclusion: Hemithyroidectomy is associated with lower complication rates, reducedneed for hormone replacement, and better quality of life compared to totalthyroidectomy for benign thyroid nodules. However, these advantages must bebalanced against the risk of recurrence and need for reoperation. The choice betweenprocedures should be individualized based on patient characteristics, preferences, andrisk profile.