Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.

Our results suggest that PTCs located in the isthmus were more likely to be associated with multifocal disease, lymph node involvement and capsule invasion, than carcinomas in other thyroid regions. Therefore, total thyroidectomy could be considered as an appropriate surgical treatment for papillary carcinomas located in the isthmus regardless of size.

Our results indicate that a high rate of PTMC presented 1 or more risk factors including multifocality, bilaterality, capsule invasion, and lymph node metastasis. Therefore, we suggest total thyroidectomy followed by adequate exploration of the central neck compartment for possible nodal involvement and resection as a safe therapeutic approach.

Patients presenting multifocal, bilateral PTMC with a maximum diameter > 5 mm and thyroid capsule invasion may have an increased risk of lymph node metastasis. These factors should be considered in the follow-up for these patients.

This study showed that TgAb positivity was an independent risk factor for PTC. A positive correlation between TgAb and PTC in patients with indeterminate nodules was existed. Additionally, a positive correlation existed between TgAb and lymph node metastases in patients with PTC. Prospective studies with a larger number of patients and long-term follow-up are needed clarify the potential role of positive serum TgAb in the prediction of PTC.