Endocrine and neurological complications in total versus completion thyroidectomy: a systematic review and meta-analysis

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.