Approach to the patient with incidental papillary microcarcinoma

Analysis of the Surveillance Epidemiology and End Results database reveals that since 1995 a 2.4-fold increase in thyroid cancer has occurred. A concomitant rise in cases of thyroid microcarcinoma has also been noted, with the frequency rising by approximately 50% as well. Increased detection of thyroid nodules, many of them below 1 cm in size, is at least partly responsible for this trend. The wide use of sensitive imaging modalities for various indications leads to the incidental discovery of thyroid nodules, some of which contain thyroid cancer, including cases of microcarcinoma. Although the vast majority of patients with thyroid cancer foci smaller than 1 cm will do exceedingly well long term, exceptions do occur, with some patients experiencing recurrence either locally or less frequently with distant metastasis. There has been some debate on the optimal management for these patients to include: extent of surgery required, the usefulness of ablation with radioactive iodine, as well as the optimal level for TSH suppression. In this article, we will review the available data and recommendations surrounding the management of patients with incidental thyroid microcarcinoma.