Furthermore, early detection and the entailing decrease in size of PTCs has changed the surgical strategy of surgeons [4]. Even in the studies from the early 1980s, Mazzaferri mentioned that for PTC patients with tumor size less than 1.5 cm in diameter, less than total thyroidectomy (i.e., unilateral lobectomy) demonstrated outcomes statistically differing insignificantly than from those results achieved with more aggressive therapy (i.e., total thyroidectomy) [1]. Recent data also demonstrated that oncologic outcomes are comparable between total thyroidectomy and thyroid lobectomy in PTMCs [5]. Provided that the oncologic outcomes are comparable, thyroid lobectomy would be a superior choice over total thyroidectomy because it would lead to less complications such a vocal cord paralysis or postoperative hypoparathyroidism [6,7].

In case of a bilaterally occurring PTC (including PTMC), however, the main surgical choice remains total thyroidectomy which makes it important to confirm the absence of tumor on the contralateral thyroid gland before performing a lobectomy. However, the rate of preoperatively undiagnosed tumor foci incidentally detected by postoperative pathological analysis has been reported to be around 15.8% to 21.3% [8]. Therefore, the aim of this article–which is identifying risk factors that may be associated with contralateral malignant nodules–is of paramount importance if a surgeon wishes to avoid unnecessary reoperations.

Unfortunately, the authors could not find any significant differences between patients with or without contralateral occult carcinoma with respect to gender, age, primary tumor size, central lymph node metastasis, extrathyroidal extension and stage [9]. Although they demonstrated that Hashimoto’s thyroiditis was associated with contralateral tumor, the diagnosis was based on postoperative surgical pathology reports (rather than by measuring serum anti-thyroid peroxidase antibodies [TPOAb] levels) which are unobtainable preoperatively. Although risk of seronegative thyroiditis does exist, we can take hint from the authors conclusion and refrain from routinely performing unilateral lobectomies for PTMCs when serum TPOAb levels indicate Hashimoto’s thyroiditis. Prospective studies utilizing serum TPOAb levels as indicators for contralateral recurrence, however, should be conducted for serum TPOAb to be accepted in clinical practice as a true indicator of contralateral recurrence.