Management of papillary microcarcinoma of the thyroid

Papillary carcinoma of the thyroid is usually an indolent tumor with a good survival prognosis especially when small and limited to the thyroid gland. The prevalence of this tumor in younger patients with long life expectancies, however, magnifies the problem of late recurrences. Current published guidelines recommend near total thyroidectomy for all differentiated thyroid cancers with the exception of small papillary carcinomas (< 1.0 cm) found coincidentally after surgery for benign disease, providing there are no other risk factors. Presentation of completion thyroidectomy as an option to the patient is recommended. Both the patient and physician should be aware that 15-20% of cases will have another focus in the contralateral lobe and that long-term recurrent disease may reach 20% or more in the absence of complete resection. Despite their small size, 5% or more of these tumors may be associated with invasion of the capsule or distant metastases (Stage III or IV). The task for patient and physician is to fairly balance these factors against the risks and cost of the additional procedures.