Comparative safety of completion thyroidectomy following lobectomy versus total thyroidectomy in differentiated thyroid cancer: A systematic review and meta-analysis.

Hypocalcemia (HC) is a common complication after thyroid surgery. This retrospective case-control study aimed to evaluate the efficacy of postoperative betamethasone infusion in reducing the incidence of HC following thyroid surgery, with recurrent laryngeal nerve palsy and other complications as secondary outcomes. A total of 196 patients who underwent total or completion thyroidectomy were retrospectively analyzed. Patients were divided into groups receiving postoperative betamethasone infusion or no glucocorticoid treatment. Postoperative data on HC incidence (at least one serum calcium measurement below 8.0 mg/dL), symptomatic HC (HC associate with numbness of the extremities, facial paresthesia, muscular spasms, and Chvostek's or Trousseau's signs), pain, recurrent laryngeal nerve palsy, voice dysfunction, sore-throat and dysphagia were collected and analyzed. Additionally, demographic and clinical characteristics were assessed, including preoperative assessments, intraoperative techniques, and postoperative recovery parameters. The study found a significantly lower incidence of HC and symptomatic HC in the betamethasone group compared to the control (32.0% vs. 49.5%, p=0.013; 11.3% vs. 25.3%, p=0.012, respectively). Betamethasone-treated patients also reported lower postoperative pain scores (p=0.002). Betamethasone infusion post-thyroidectomy demonstrated efficacy in reducing HC and symptomatic hypoparathyroidism, with minimal impact on other complications. The findings suggest the potential of glucocorticoids as a therapeutic option in thyroid surgery to enhance postoperative outcomes and patient recovery.

One of the most serious potential complications of thyroid surgery is temporary or permanent dysfunction of the recurrent laryngeal nerve. According to the literature, the development of nerve injury is influenced by several predictive factors, including demographic, surgical and pathological factors. The aim of our research was to determine the prevalence of temporary and permanent vocal cord paralysis following thyroid surgery in our patient population, and to identify preoperative factors that may be associated with the development of paralysis. We retrospectively analyzed the data of patients who underwent thyroid surgery between January 1, 2022 and March 31, 2024. In addition to demographic data, we examined the surgical indication, interventional procedure and postoperative histological results. Fisher's exact test and multivariate regression analysis were used to analyze whether age 65 years or older, malignant indication, and total thyroidectomy had prognostic significance for recurrent laryngeal nerve injury. During the study period, a total of 155 operations were performed on 153 patients (125 women, 30 men; mean age: 53.7 years) (nerve at risk: 227). Of these, 143 were primary operations, 11 were completion thyroidectomies and 1 was reoperation; 83 cases were lobectomy, 72 cases were total thyroidectomy. The surgical indication was benign in 123 cases (category II-IV according to The Bethesda System for Reporting Thyroid Cytopathology [2023], drug-resistant hyperthyroidism, compression symptoms), and malignant in 32 cases (category V-VI, contralateral malignancy, cold nodule). Histological examination confirmed 128 benign and 27 malignant lesions. Immediate postoperative laryngeal dysmotility occurred in 18 cases (nerve at risk: 19; 8.4%). 4 patients were lost to follow-up, so 11 cases (5.0% of 220 nerve at risk) proved to be temporary and 3 cases (1.4% of 220 nerve at risk) proved to be permanent paralysis. Statistical analysis did not confirm any of the examined factors as independent predictors. The incidence of postoperative laryngeal paralysis was in line with international data, and none of the examined potential risk factors were able to prove their prognostic significance, so the personalized risk assessment still relies primarily on literature data in our practice. Orv Hetil. 2026; 167(26): 1034-1040.

Postoperative pneumothorax (PPTX) after thyroidectomy (TD) or parathyroidectomy (PT) is rare and primarily described in case reports with limited data on its prognostic significance in large populations. We aim to assess the incidence of PPTX and its association with clinical outcomes following TD or PT. We queried the TriNetX United States Research Network, identifying patients ≥ 18 years of age who underwent open TD or PT between January 2000 and December 2025. Patients were separated by development of PTX within 7 days postoperatively. Outcomes were assessed at 3 and 6 months using odds ratios (ORs) and at 1 year using hazard ratios (HRs), with 95% confidence intervals (CIs). The primary outcome was all-cause mortality; secondary outcomes included risks for pneumonia, dysphagia, vocal cord paralysis, and need for mechanical ventilation as well as healthcare utilization rates. Among 228,340 patients undergoing surgery, 237 (0.10%) developed PPTX. At 1 year, PPTX was associated with increased risk of all-cause mortality (HR 16.44, 95% CI 11.16-24.23), pneumonia (HR 6.14, 95% CI 3.48-10.83), dysphagia (HR 4.86, 95% CI 3.23-7.33), vocal cord paralysis (HR 5.19, 95% CI 3.31-8.15), and need for mechanical ventilation (HR 18.13, 95% CI 10.89-30.17). PPTX was also associated with higher rates of hospital readmission (HR 15.12, 95% CI 11.97-19.10) and emergency room visits (HR 2.09, 95% CI 1.33-2.28) (all p < 0.01). All outcomes were also significant at 3 and 6 months after surgery. PPTX after TD or PT is exceedingly uncommon but associated with significantly worse mortality and morbidity.

Recurrent laryngeal nerve (RLN) dysfunction represents one of the most feared complications of thyroid surgery, with significant impacts on patients' quality of life due to the potential paralysis of the vocal cords. Although nerve transection is rare, functional loss - non-structural and invisible to the human eye - is the primary cause of this complication. Intraoperative nerve monitoring (IONM), introduced more than 50 years ago and significantly improved over the past decade, represents a crucial tool for preventing this outcome. This retrospective observational study involves patients undergoing total or partial thyroidectomy at a specialized center in Italy from 2023 to the present and aims to compare the predictive effectiveness of vagus nerve (VN) stimulation versus RLN stimulation, evaluating three techniques (C-IONM, I-IONM, and No-IONM). All patients were monitored using a NIM system (NIM Avalanche SI2), with pre- and postoperative laryngoscopic evaluation. Among 378 patients undergoing thyroid surgery, no significant differences in baseline demographics were observed among groups. The absence of intraoperative neuromonitoring was associated with a significantly higher risk of permanent vocal cord paralysis compared with I-IONM (OR 4.84, P=0.012). C-IONM showed no cases of permanent paralysis and was associated with significantly shorter operative time and reduced length of hospital stay compared with both intermittent monitoring and no monitoring. I-IONM significantly improves neurological safety in thyroid surgery. C-IONM provides the most favorable overall profile, combining comparable safety with improved operative efficiency and postoperative recovery, and represents a promising strategy for further optimization of surgical outcomes.

The anatomical relationship of the inferior thyroid artery (ITA) and the recurrent laryngeal nerve (RLN) is highly variable. This study aims to evaluate bilateral RLN branching patterns and their relationship to the ITA within the same patient, predicting contralateral anatomical variations and ultimately reducing intraoperative risk of RLN injury. A retrospective review of prospectively collected intraoperative data was performed on adults undergoing total or completion thyroidectomy at a tertiary center between February 2022 and June 2025, with standardized documentation and intermittent nerve monitoring in all cases. RLN-ITA relation was classified as posterior, anterior, or between branches, and RLN morphology as single, bifurcated, or plexiform. Bilateral agreement, conditional probabilities, and predictors were evaluated using Cohen's κ and McNemar's test. Seventy-five patients (150 RLNs) were included. Overall RLN-ITA relations were posterior 72.7%, anterior 24.7%, and between branches 2.7%. Extra-laryngeal branching was observed in 24.7% of nerves (18% bifurcated, 6.7% plexiform). High bilateral agreement was demonstrated (κ = 0.83, p < 0.001), with 93.3% concordance between sides. When variation was present on one side, the probability of contralateral variation was 94.7% (left) and 81.8% (right). Variant RLN-ITA relations were associated with larger median lobe volumes (21.7 vs. 12.3 mL), thought this trend did not reach statistical significance. Our study reveals a high degree of intra-patient symmetry in both recurrent laryngeal nerve (RLN) branching patterns and the RLN-ITA relationship, highlighting that anatomical variations are often mirrored contralaterally. While further larger-scale studies are necessary to confirm the reproducibility of these findings, the identification of an RLN variation on one side should prompt greater caution during contralateral dissection.

Risk stratification systems (RSSs) have had an increasing role in standardizing thyroid ultrasound reports. The VA Northern California Healthcare System (VA-NCHCS) Radiology department adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018. We aimed to assess what effect the adoption of TI-RADS at VA-NCHCS had on thyroid surgical practices. A 10-year retrospective review of the VA corporate data warehouse was completed (approximately 5 years prior and 5 years after universal adoption of TI-RADS) (i.e: 1/1/2013-7/1/2018 and 7/2/2018-12/30/2023). Using CPT and diagnosis codes, data were collected on all thyroid surgeries, including demographics, type of surgery performed, final pathology, staging of malignancy, and any incidental findings. A two-sample t-test with equal and unequal variances was used for comparative statistics. 3985 patients (1921 PRE-TIRADS vs. 2064 POST-TIRADS) and 7908 thyroid ultrasounds (3411 vs. 4497) were identified. 2859 FNAs were performed (1245 vs. 1614). One hundred and ninety-three surgeries (96 vs. 97) were performed with a decreasing trend in surgeries for benign pathology (56 vs. 45) and an increasing trend in surgeries for malignancy (39 vs. 51). We identified an increase in partial thyroidectomy surgeries for cancer diagnoses (11 vs. 18). Finally, there was a significant decrease in total thyroidectomies performed for benign pathology (30 vs. 13, p = 0.02). After the institution of TIRADs at our single institution, there was a dramatic increase in the number of ultrasounds and FNAs performed, despite near stable thyroid surgical numbers. There was a significant trend towards less-invasive surgical practices.

Ambulatory thyroidectomy: A paradigm shift in surgical safety and patient-centered care.

To identify clinical risk factors for dysphagia after iodine-131 ( 131 I) therapy in patients with papillary thyroid carcinoma (PTC) and develop a validated risk-prediction nomogram. Adult PTC patients treated with 131 I at the Department of Nuclear Medicine, Affiliated Hospital of Xuzhou Medical University, between January 2022 and October 2024 were retrospectively reviewed. All patients underwent total or partial thyroidectomy, had satisfactory postoperative wound healing, and had histopathologically confirmed PTC. Baseline clinical data, laboratory parameters, and pretreatment salivary gland function assessed by dynamic pertechnetate single-photon emission computed tomography/computed tomography were collected. Swallowing function was evaluated before treatment and at 6-month follow-up using the MD Anderson Dysphagia Inventory; dysphagia was defined as a total score less than 50. Variables significant in univariate analysis were entered into backward stepwise multivariate logistic regression. Independent predictors were used to construct a nomogram, which was assessed by area under the curve (AUC), bootstrap calibration, and decision curve analysis. Among 201 patients, 68 (33.8%) developed dysphagia. Higher cumulative 131 I dose, smoking history, and baseline salivary gland dysfunction were independent predictors of dysphagia. The nomogram incorporating these factors showed excellent discrimination, with an AUC of 0.913, good calibration with a bootstrap mean absolute error of 0.013, and favorable clinical net benefit. Higher 131 I dose, smoking history, and pre-existing salivary gland dysfunction independently predict dysphagia after 131 I therapy in PTC patients. This nomogram may support individualized risk assessment and preventive counseling before treatment.

A Practical Nomogram for Preoperative Prediction of Lateral Lymph Node Metastasis in Children and Adolescent Patients With Papillary Thyroid Carcinoma: A Multicenter Retrospective Study.

Lithium is a commonly used mood stabilizer in managing bipolar disorder. While its therapeutic benefits are well-documented, its potential to induce thyroid-related disorders has long been recognized. Hypothyroidism is the most common thyroid dysfunction associated with lithium, though lithium-induced thyroiditis remains a rare and often overlooked complication. In this report, we describe a thyroid nodule initially diagnosed as "high-grade thyroid carcinoma" due to severe histomorphologic changes at an outside institution, which was later reclassified at our review as an iatrogenic effect of long-term lithium therapy. Preoperative fine needle aspiration, interpreted as "atypical follicular neoplasm (Bethesda Category IV)," prompted a diagnostic right lobectomy. No molecular testing was performed. The lobectomy was misinterpreted as carcinoma, leading to completion thyroidectomy. Histologic features included intersecting fibrosis, patchy lymphocytic inflammation, hyperplastic changes with pseudopapillary formation, nuclear pleomorphism with hyperchromasia, and giant cell formation, but notably absent were mitotic activity and necrosis, which are required for poorly differentiated or differentiated high-grade thyroid carcinoma under the 2022 WHO criteria. The patient's long history of lithium therapy was instrumental in recognizing the functional origin of the thyroid changes, which, if identified earlier, could have prevented unnecessary completion surgery. This report highlights the evolving diagnostic criteria for thyroid tumors, illustrating how lithium-associated thyroiditis can mimic malignancy and lead to overtreatment if historical context is not considered.

American Thyroid Association (ATA) argues that the prevalence of malignancy of the indeterminate nodules may vary substantially among regions, and states that it is crucial to know the prevalence of malignancy within each indeterminate cytological category at one's institution. Our aim is to draw attention to the malignancy rates of indeterminate nodules that cannot be underestimated in an endemic region and raise awareness to differences across different populations. Between March-2021 and June-2024, 13,531 fine needle aspirations were performed on thyroid nodules in a single institution. Of these 2121 nodules were classified as indeterminate (Bethesda III-IV) and 242 patients underwent surgery. Demographic characteristics, nodule size, risk of malignancy, tumor types and subtypes were evaluated. The necessity of radioactive iodine (RAI) therapy and consequent completion thyroidectomy was investigated. Of the 242 patients 123 (50.8%) underwent lobectomy and 119 (49.2%) underwent total thyroidectomy. In total, 115 (47.5%) of 242 patients resulted in malignancy (186 patients were Bethesda-III and 82 (44.1%) of them were malignant; 56 were Bethesda-IV and 33 (58.9%) of them were malignant). Incidental carcinoma was detected in a different focus other than the indeterminate nodule in 17 patients. RAI therapy was indicated in 39 patients (33.9%) primarily based on the ATA guideline, and 24 (20.8%) patients who initially underwent lobectomy required completion thyroidectomy. Risk of malignancy in indeterminate thyroid nodules varies endemically. Each region should know their own risk and each patient's treatment should be tailored accordingly. In this way, under-overtreatment and related morbidities will be prevented.

Objective: To identify clinical factors, may it be patient, procedure, or tumor-related, associated with hypocalcemia post-thyroidectomyMethods:Design: Case Series with Planned Data CollectionSetting: Tertiary National University HospitalParticipants: Total enumeration reviewed records of 664 patients aged 19 years old and above, previously admitted under the Philippine General Hospital Department of Otolaryngology – Head and Neck Surgery from 2019 to 2023 who underwent total thyroidectomy (including completion thyroidectomy and those with neck dissection) and had serum calcium determination done both 6 and 24 hours post-operation. Cumulative incidence of hypocalcemia was determined, and patient-related, procedure-related, and tumor-related factors were investigated, with multivariable logistic regression analysis performed to identify the association between clinical factors and postoperative hypocalcemia. Results: The cumulative incidence of hypocalcemia at 6 hours and 24 hours post-operation was 28.92% (95%CI: 25.49%–32.53%) and 19.49% (95%CI: 16.01%–23.36%), respectively. The clinical factors with notable increased odds for postoperative hypocalcemia were female sex (adjusted OR: 3.5; 95%CI: 1.2623–9.6362), total thyroidectomy as type of surgery (adjusted OR: 0.7; 95%CI: 0.2905–1.6805; adjusted OR: 0.8; 95%CI: 0.2616–2.6670), histopathologic type of papillary thyroid carcinoma (adjusted OR: 1.4; 95%CI: 0.8949–2.0719; adjusted OR: 1.6, 95%CI: 0.8985 2.7771), and the presence of parathyroid tissue in the excised specimen (adjusted OR: 1.2; 95%CI: 0.7436–1.9002; adjusted OR: 1.6; 95%CI: 0.8406–2.9496). The only statistically significant factor out of all those investigated was female sex. Conclusion: The only statistically significant clinical factor associated with hypocalcemia in our study was female sex, with total thyroidectomy as type of surgery, histopathologic type of papillary thyroid carcinoma, and presence of parathyroid tissue in the excised specimen as other factors noted with increased odds for hypocalcemia.

Background: Overall, the management of thyroid disease still relies heavily on total thyroidectomy. Aim: The aim of the study was to describe the clinical manifestations, indications, and complications of total thyroidectomy performed for thyroid diseases in Sulaymaniyah, Shar, and Surgical teaching hospitals. Patients and Methods: A retrospective, descriptive cross-sectional study was conducted, including 167 patients who received total thyroidectomies at Sulaymaniyah Surgical Teaching Hospital and Shar Teaching Hospital in Sulaymaniyah City, Iraq, between January 1, 2020, and December 31, 2024. The data collected through a constructed questionnaire, which was filled out from patient chart files, was one of the study’s instruments. Telephone calls were made to inquire about the patients’ post-thyroidectomy problems and thyroxine dosage. Results: Out of the 167 patients who underwent total thyroidectomy, 147 were female. A total of 96 patients reported neck swelling, with 12 patients experiencing neck pain before surgery. In addition, 65 patients reported breathing difficulties, while others presented other clinical symptoms. 132 patients presented with benign multinodular goiter (MNG), toxic goiter, or diffuse goiter, while 35 patients were diagnosed with thyroid cancer or had suspicious glandular characteristics. 136 experienced no post-operative complications, whereas three individuals suffered from chronic voice change and persistent dyspnea. Conclusion: The predominant complaint of patients who underwent total thyroidectomy was neck swelling with neck discomfort before surgery. Patients diagnosed with MNG and thyroid cancer had a complete thyroidectomy. During post-operative follow-up, permanent voice change and permanent dyspnea were observed in some cases.

Total thyroidectomy or hemithyroidectomy for differentiated thyroid carcinoma?

Thyroid disease incidence has increased over the last three decades, but mortality has been stable. Our study assessed the trends and geographical variation in thyroid procedures across Australia over a 10-year period which spanned the introduction of the American Thyroid Association (ATA) Guidelines in 2015 and therefore aimed to capture any resulting changes in practice, as well as other factors influencing geographic variability. Medicare Benefits Scheme (MBS) data was extracted for items 30296 (Total Thyroidectomy), 30306 (Hemithyroidectomy), and 30310 (Partial Thyroidectomy) between January 2014 and December 2023. We calculated absolute and relative per capita frequencies for Total and Partial Thyroidectomy subgroups and assessed trends over time, as well as geographic variability. The total number of thyroid procedures performed per year did not increase significantly over the study period (5824 in 2014 vs. 6434 in 2023, p > 0.05); however, the number of Partial Thyroidectomies significantly increased (2899 in 2014 vs. 3934 in 2023, p < 0.01), and Total Thyroidectomies significantly decreased (2925 in 2014 vs. 2500 in 2023, p < 0.01). The per-capita state-based rate for all thyroidectomy procedures varied by 300% (93 procedures-per-capita in NT vs. 279 procedures-per-capita in NSW). The rate of change in different thyroid procedures over time in our study and our findings of lower geographical variation compared to studies conducted prior to 2015 suggest that ATA Guidelines may have reduced the contribution of physician-related factors to geographic variability and de-escalated the extent of procedures for patients with low-risk pathology. Geographic variation is, however, multifactorial, and these findings also likely reflect other factors like socioeconomic status and access to healthcare.

Unexpected Hyperthyroidism After Partial Thyroidectomy in a Patient With Hashimoto’s Hypothyroidism

Background: Hypocalcemia is the most frequent complication following total thyroidectomy (TT), associated with neuromuscular symptoms and prolonged hospitalization. Although prophylactic oral calcium supplementation is commonly used to prevent postoperative hypocalcemia, its routine use remains debated.Objective: This study aimed to assess the effectiveness of immediate postoperative oral calcium supplementation in reducing the incidence of hypocalcemia following thyroidectomy.Methods: This single-center retrospective cohort study included patients who underwent TT or partial thyroidectomy (PT) between January 2018 and December 2022. Patients were categorized into two groups: those who received immediate postoperative oral calcium prophylaxis (most commonly calcium carbonate 500-1000 mg daily, with or without vitamin D, based on surgeon preference) and those who received standard care without prophylaxis. The primary outcome was hypocalcemia within 48 hours, defined as total serum calcium <8.5 mg/dL and/or the presence of clinical symptoms. Categorical variables were compared using the chi-square test, and statistical significance was set at p < 0.05.Results: Seventy-four patients were initially screened; 72 patients (mean age: 44.9 ± 12 years; 82.4% female) were included in the final analysis after excluding two with missing postoperative data. Among them, 21 received calcium prophylaxis and 51 received standard care. Hypocalcemia occurred in 0% of patients in the prophylaxis group compared to 35.3% in the control group (p = 0.002). Stratified analysis of the high-risk TT group (n=52) showed a significant reduction in hypocalcemia from 54.5% (18/33) in the control group to 0% (0/19) in the prophylaxis group (p < 0.001). No adverse events related to calcium supplementation were observed.Conclusions: Immediate postoperative oral calcium supplementation significantly reduces early postoperative hypocalcemia after thyroidectomy. Given its safety, low cost, and clinical effectiveness, routine calcium prophylaxis should be considered as part of standardized postoperative care. Further prospective multicenter trials are warranted to validate these findings.

To determine the clinical presentation, subtypes, and surgical outcomes of patients undergoing surgery for thyroid cancer at a tertiary care hospital in Karachi. A case series. Place and Duration of the Study: Department of ENT Head and Neck Surgery, PNS Shifa Hospital, Karachi, Pakistan, from January 2015 to December 2024. Patients who underwent surgery for thyroid swelling and were diagnosed with thyroid cancers through biopsy were selected. All of these patients presented with a solitary thyroid nodule; four patients with multinodular goitre but post-thyroidectomy histopathology showed malignancy. Data on demographics, FNAC categories, surgical approaches, and complications were analysed. Among 70 patients out of 470, 11 (15.71%) were male, and 59 (84.29%) were female, with a male-to-female ratio of 1:1.53 and a mean age of 43.4 ± 8.5 years. The majority of the patients (n = 60, 85.7%) were euthyroid on initial screening preoperatively. In 7 patients, preoperative FNAC was Thy 2; therefore, the first lobectomy was performed, and upon final histopathology, completion thyroidectomy was undertaken. Papillary carcinoma was the most prevalent subtype (84.51%). Central neck dissection was performed in 62.9% of cases. Overall, positive lymph nodes were present in 23 out of 70 cases (32.8%). Complications included temporary hypocalcaemia (31.4%) and recurrent laryngeal nerve palsy (7.1%). No local or nodal recurrence was observed over the follow-up period. Papillary thyroid carcinoma predominates among thyroid malignancies, with favourable surgical outcomes and low complication rates. Comprehensive preoperative evaluation and appropriate surgical techniques are critical for optimal outcomes. Thyroid tumour, Thyroid malignancy, Papillary carcinoma, Follicular carcinoma, Differentiated thyroid cancer.

The optimal extent of thyroidectomy remains controversial. Total thyroidectomy (TT) offers definitive disease control but it may raise the complications and completion thyroidectomy (CT) following initial lobectomy might lower the morbidity. This meta-analysis and systematic review compared TT and CT using endocrine and neurological outcomes in the postoperative period. We searched databases of PubMed, Scopus, Embase, Web of Science and Google Scholar in accordance with PRISMA and until September 1, 2025. Articles that reported postoperative endocrine and neurological complications of both TT and CT were selected. Quality evaluation was assessed by Joanna Briggs Institute (JBI). The random-effects model in STATA 17 was used to compute pooled odds ratios (ORs), and heterogeneity was assessed using I 2 and Cochran Q. Sensitivity analyses were done to determine the strength of findings. Forty-nine articles were incorporated. TT was related to increased odds of overall hypocalcemia (OR = 1.74; 95% CI: 1.302.34), transient hypocalcemia (OR = 1.67; 95% CI: 1.09 2.55), and transient hypoparathyroidism (OR = 1.53; 95% CI: 1.002.33) in comparison with CT, whereas permanent hypocalcemia was increased moderately (OR = 1.27; 95% CI: 1.16–1.40). Neurological, such as recurrent laryngeal nerve (RLN) palsy (OR = 0.90; 95% CI: 0.671.21) and the RLN injury (OR = 0.45; 95% CI: 0.151.05) showed no significant results between the two procedures. These results were validated by sensitivity analyses on the consistency of the results across the study quality strata. TT is linked to higher occurrence of transient endocrine complications but is equal to CT regarding neurological safety. These findings emphasize the role of personalized surgical decision-making, careful parathyroid conservation, and standardized perioperative care as ways of reducing the risk of complications and maximizing the outcome of thyroid surgery. Not applicable.