Initial Total Thyroidectomy Versus Lobectomy with Intraoperative Frozen Section for Thyroid Nodules That Are “Suspicious for PTC”

Abstract

The optimal surgical management for a thyroid nodule that is `suspicious for papillary thyroid carcinoma (PTC)' remains unclear. Surgical options include (1) lobectomy with intraoperative frozen section or (2) initial total thyroidectomy. To help address this clinical question we employ the GRADE approach. The current literature was reviewed, and outcomes were assessed for their impact on clinical decision-making as related to thyroid surgery. Based on our review of the literature, it is clear that there is currently a paucity of high-to-moderate quality evidence regarding the treatment of patients with thyroid nodules that are `suspicious for PTC'. Important aspects to consider in the decision-making process are (1) accuracy of diagnosis and (2) relative risk of surgery. When considering the available evidence, assuming relatively low complication rates by experienced surgeons, initial total thyroidectomy may be recommended.