Despite promising findings from international studies, the use of microscopic thyroidectomy remains limited in local surgical practice, where conventional thyroidectomy is traditionally followed. There is a scarcity of local data evaluating the benefits of MT, and inconsistencies in reported outcomes highlight the need for further research. The lack of standardized protocols and limited surgeon experience with microscopic techniques contribute to hesitation in its adoption.

This study aims to address the research gap by providing comparative data on operative time, intraoperative blood loss, and postoperative complications in microscopic versus conventional thyroidectomy in our setting. The findings will aid in determining whether MT should be incorporated into routine surgical practice to improve patient outcomes and reduce postoperative complications.

Thyroid disorders requiring surgical intervention are common, with conditions such as multi nodular goiter, thyroid malignancies, and hyperthyroidism frequently necessitating thyroidectomy. The procedure, while effective, poses risks due to the intricate anatomy of the thyroid gland and its proximity to critical structures such as the recurrent laryngeal nerve (RLN), external branch of the superior laryngeal nerve (EBSLN), and parathyroid glands. Complications like RLN palsy, hypocalcemia, and hematoma can result in significant morbidity. Hypocalcemia occurs in 20%-30% of cases, while RLN injury is reported in 5%-11%, with bilateral RLN paralysis being a rare but life-threatening complication. Minimizing these risks requires precise surgical techniques, adequate anatomical knowledge, and surgeon expertise. Thyroid surgery has evolved significantly, incorporating various approaches to enhance safety and outcomes. Conventional thyroidectomy (CT) remains the standard procedure, providing direct visualization and effective gland excision. Endoscopic thyroidectomy, utilizing minimal access techniques, has improved cosmetic outcomes but often involves longer operative times. The use of robotic-assisted thyroidectomy has further advanced precision, though cost and availability remain limiting factors. Microscopic thyroidectomy (MT), which involves magnification techniques for enhanced visualization, has been introduced to minimize complications. Studies suggest MT offers superior preservation of RLN, EBSLN, and parathyroid glands, reducing transient nerve palsies and hypocalcemia rates compared to conventional approaches.

However, it is essential to assess its efficacy in routine clinical practice.

Inclusion Criteria:

• Both Male or female patients.
• Patients aged 18 to 65 years undergoing thyroidectomy for benign or malignant thyroid disease.
• Patients with multinodular goiter, Grave's disease, thyroid carcinoma indicated for surgery based on their workup.
• Candidates scheduled for unilateral lobectomy, subtotal thyroidectomy, or total thyroidectomy.
• Patients with preoperative normal vocal cord mobility confirmed by laryngoscopy.

Hemodynamically stable patients without significant comorbidities affecting surgery or anesthesia based on ASA classification (Class I-III).

• Patients who provide informed consent to participate in the study.

Exclusion Criteria:

• Prior history of prior thyroid surgery.

• Patients with evidence of lateral lymph node metastasis or local invasion on preoperative imaging (ultrasonography or computed tomography).
• Patients with pre-existing hypocalcemia or parathyroid disorders.
• Patients with severe medical comorbidities, including uncontrolled diabetes (HbA1c > 8%), chronic kidney disease (eGFR < 30 mL/min/1.73m²), liver cirrhosis (Child-Pugh class B or C), or coagulopathy (INR > 1.5 or platelet count < 50,000/μL), will be excluded from the study.
• Pregnant or lactating women.
• Patients with invasive thyroid carcinoma, anaplastic thyroid carcinoma, or thyroid lymphoma requiring extensive radical surgery.