Is lobectomy an appropriate surgical strategy for nodular goiter in endemic areas?

Introduction: Thyroid nodules are evaluated by fine-needle aspiration biopsy (FNAB) according to their radiologic characteristics. International guidelines recommend lobectomy according to the size of the nodules and FNAB results. The aim of this study is to assess whether lobectomy is one of the treatment choices in endemic areas. Methods: Patients who underwent lobectomy between January 2013 and September 2017 were studied retrospectively. Patients’ demographic features, thyroid hormone levels, medications, FNAB results before the surgery, lobectomy indications, ultrasonographic features, final pathologies, and secondary surgical interventions were recorded. Results: Data of 388 patients who underwent lobectomy were examined. As patients were classified according to their FNAB results, all categories had higher malignancy rates than expected in the final pathology results. One hundred and eighteen (30.4%) patients had undergone completion thyroidectomy. The final pathology of the completion thyroidectomy samples showed 24.07% (n=26) malignancy. Discussion and Conclusion: FNAB is the gold standard for the malignancy risks in thyroid nodules in all guidelines. In endemic areas, this classification system may be inadequate. Two-staged thyroid surgery is becoming more popular. In our series, 30.4% of patients had undergone completion thyroidectomy according to their final pathology results. We need to add newer sights to guidelines for endemic areas.