Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Differentiated thyroid cancers, particularly papillary thyroid carcinoma, have increased in incidence worldwide. For carefully selected low-risk disease, thyroid lobectomy is increasingly used to reduce surgical morbidity, although some patients later require completion thyroidectomy due to postoperative histopathological findings. Aim of the study: To evaluate the risk of requiring completion thyroidectomy among patients with low-risk papillary thyroid carcinoma treated initially with thyroid lobectomy. Patients and methods: A prospective observational cohort study was conducted at Baghdad Teaching Hospital, Medical City Complex, including 45 patients managed between 1 January 2025 and 1 January 2026. Baseline clinical, ultrasound, cytology, operative, and histopathological variables were collected. Logistic regression analyses were performed to identify predictors of completion thyroidectomy. Results: The cohort included 45 patients with a mean age of 45.6 ± 8.4 years; 71.1% were female. Mean preoperative nodule size was 1.74 ± 0.53 cm. Completion thyroidectomy was performed in 62.2%, with a mean interval of 1.9 ± 0.5 months. Postoperative hypocalcemia occurred in 26.7% and hematoma in 8.9%. In multivariable analysis, larger nodule size (adjusted odds ratio 6.59 per 1 cm; 95% confidence interval 1.28–33.91; probability value = 0.024), preoperative multifocality (adjusted odds ratio 5.20; 95% confidence interval 1.03–26.39; probability value = 0.046), and Bethesda category V cytology (adjusted odds ratio 9.56; 95% confidence interval 1.47–62.09; probability value = 0.018) were significant predictors. Conclusion: A substantial proportion of low-risk papillary thyroid carcinoma patients treated with lobectomy required completion thyroidectomy. Nodule size, preoperative multifocality, and Bethesda category V cytology were independent predictors, supporting enhanced preoperative counseling and risk-adapted surgical planning.