[Treatment of papillary microcarcinoma of the thyroid]

We retrospectively analyzed the recurrence, distant metastases and mortality of 78 patients with papillary microcarcinoma during a mean period of 6.8 years. None of the 56 patients with unifocal tumors without metastases relapsed, irrespective of the type of treatment (22 submitted to lobectomy, 11 to total thyroidectomy without ablation and 23 with ablation). The same occurred for the 15 cases of multicentric tumors restricted to the thyroid and treated with total thyroidectomy and radioiodine. Of the 7 patients with metastases in the initial presentation and treated with extensive surgery and ablative therapy, cervical recurrence was observed in 1 case. Detectable anti-thyroglobulin antibodies were more common after lobectomy (22.7% vs. 9%) and the specificity of thyroglobulin was compromised by this procedure, but not in patients submitted to total thyroidectomy without ablation. Two cases of definitive hypoparathyroidism were observed in the group submitted to total thyroidectomy (3.5%) and no cases with lobectomy. The present study agrees that lobectomy can be sufficient for the treatment of single microcarcinoma restricted to the thyroid. However, the Tg specificity is compromised. Total thyroidectomy is recommended for multicentric tumors or with lymph nodes metastases, but the routine use of radioiodine is a matter of controversy.