Long-Term Outcomes of Microcarcinoma of the Thyroid: A Retrospective Analysis of Surgical Management and Complications

Background: Thyroid microcarcinoma, defined as papillary thyroid carcinoma ≤1 cm, has become an increasingly frequent diagnosis due to the widespread use of ultrasonography and cytology. Although survival outcomes are excellent, the optimal management strategy—active surveillance versus surgery—remains debated. Limited Indian data exist on long-term outcomes and complication patterns, particularly wound-related morbidity.

Objectives: To evaluate long-term recurrence rates, survival outcomes, and postoperative complications in patients with thyroid microcarcinoma undergoing surgery at a tertiary care center in India, with special emphasis on wound dehiscence and its predictors.

Materials and Methods: This retrospective observational study reviewed records of patients with histologically confirmed thyroid microcarcinoma operated between 2022 and 2024 at Churachandpur Medical College. A total of 172 patients (122 females, 50 males; mean age 44.2 ± 11.6 years) were included after applying eligibility criteria. Demographic, clinical, surgical, and follow-up data were analyzed. Survival outcomes were estimated by Kaplan–Meier analysis, and predictors of recurrence and complications were identified using logistic regression.

Results: Of 172 patients, 39.5% underwent total thyroidectomy and 60.5% lobectomy. Central neck dissection was performed in 12.8%, multifocal tumors were observed in 13.9%, and extrathyroidal extension in 9.3%. Postoperative complications occurred in 12.2%, with transient hypocalcemia (15%), recurrent laryngeal nerve palsy (5.8%), and wound dehiscence (4.1%) being most frequent. Diabetes (OR 2.1, p=0.03) and obesity (OR 1.9, p=0.04) independently predicted wound dehiscence. After a median follow-up of 7.8 years, recurrence occurred in 8.1%, predominantly nodal. The 10-year disease-free survival was 92%, and overall survival was 96%. Multifocality (OR 2.5, p=0.01) and nodal positivity (OR 3.2, p=0.002) were significant predictors of recurrence.

Conclusion: Surgical management of thyroid microcarcinoma provides excellent long-term outcomes in the Indian setting. Lobectomy appears adequate for selected low-risk patients, while comorbidities such as diabetes and obesity significantly increase wound-related complications. Individualized surgical planning, comorbidity optimization, and structured follow-up protocols are recommended. Larger multicentric studies are needed to develop region-specific guidelines.