Small differentiated thyroid cancer: time to reconsider clinical management and treatment

The incidence of differentiated thyroid cancer (DTC) is increasing worldwide, especially among small (≤2 cm) tumors. Overall, small DTC have an excellent prognosis and low mortality rate. Still, a proportion of these patients will experience recurrent/persistent disease. Careful risk stratification makes it possible to individualize treatment, avoiding unnecessary procedures and guarantees a good long-term prognosis with low recurrence risk. Recent studies evaluated the impact of the extent of surgery and radioiodine therapy, providing new evidence regarding treatment approach. Therefore, is time to reconsider clinical management and treatment of small DTC. Based on current data, in patients with small tumors and no additional risk factors, a conservative surgical approach without radioiodine therapy might be appropriated. More extensive surgery and radioiodine therapy could be proposed for small tumors exhibiting more aggressive features, such as lymph node metastasis, multifocality, vascular involvement, extra-thyroidal invasion or unfavorable molecular biology.