The extent of initial surgical resection for low-risk papillary thyroid carcinoma (PTC) remains controversial. While traditional practice favored total thyroidectomy (TT), latest ATA guidelines endorse a less aggressive initial approach. Nevertheless, their impact in real clinical practice remains uncertain. This study aims to assess changes in the initial surgical management of low-risk PTC at a high-volume center following the adoption of current ATA guidelines. Additionally, we sought to evaluate the resulting impact on postoperative outcomes.

We conducted a retrospective analysis of 594 consecutive patients surgically treated for localized low-risk PTC between January 2019 and December 2022. Temporal trends in reported initial surgical approaches (TT vs. thyroid lobectomy, TL) were described, stratified by demographic characteristics and tumor size (<1cm, 1-2cm, 2-4cm). The impact of ATA guidelines on the need for completion thyroidectomy and postoperative outcomes was assessed.

TL increased significantly from 23% in 2019 to 35% in 2022 (p<0.001). A gradual shift towards lobectomy a was observed for microcarcinomas (34% in 2019 to 56% in 2022) and 1-2 cm lesions (17.4% to 29%). TT remained the primary choice for nodules >2cm. The completion thyroidectomy rate following TL progressively declined. These trends were consistent across demographic groups. As TL rates increased, the incidence of hypoparathyroidism decreased from 12% in 2019 to 5.6% in 2022 (p<0.001).

An increasing less aggressive initial surgical approach is preferred for low-risk PTC, resulting in improved postoperative outcomes. Despite a slower-than-expected adoption of ATA guidelines in clinical practice, ongoing evidence of their effectiveness and safety suggests future increased utilization.