J Endocr Surg.  2018 Jun;18(2):110-120. 10.16956/jes.2018.18.2.110.

Treatment Decision Making in Papillary Thyroid Microcarcinoma

• Navarra G
• Zanghì GN
• Freni F
• Galletti B
• Galletti F
• Pagano G
• Cogliandolo A
• Barbera A
• Lazzara S
• Dionigi G

• KMID: 2420766
• DOI: http://doi.org/10.16956/jes.2018.18.2.110

Abstract

The objective of this article is to detail the treatment for papillary thyroid microcarcinoma (PTMC). The literature presents only few contributions, with controversial results, about comparison between "˜active surveillance' and surgery. Hemithyroidectomy is the treatment of choice for PTMC. Thyroidectomy is indicated in cases of multifocality, extrathyroid tumor growth, and familial PTMCs. Active surveillance can only be done under well-defined and controlled conditions. Collected findings and agreements with the patient must be precisely documented, also for medico-legal reasons. An observation of PTMC seems most appropriate for patients >60 years of age. In the case of observation of a PTMC, a lifelong examination of the tumor disease must be carried out, since tumor growth or metastases can still occur after 10-15 years. The follow-up periods for the "˜active surveillance' proposed from the literature review are too short to conclude this as a real alternative.

Keyword

Papillary thyroid microcarcinoma; Surgery; Thyroid nodule

MeSH Terms

Decision Making*
Follow-Up Studies
Humans
Neoplasm Metastasis
Thyroid Gland*
Thyroid Nodule
Thyroidectomy

Figure

• 

  Fig. 1. Schematic representation of the anatomical relationship between a PTMC of the thyroid gland, the tracheal wall, the RLN and strap muscles to plan the further course of therapy (active surveillance vs. surgery). Risk of ‘tracheal’ infiltration by a PTMC: (A) angle at high risk; (B) almost right angle - middle risk; (C) round shape tumor angle - low risk. Risk of infiltration of ‘soft tissue and muscles’ by PTMC: (D) small PTMC contained in the isthmus; (E) isthmus PTMC extending anteriorly to connective tissue; (F) lobe PTMC extending laterally to connective tissue. Risk of infiltration of ‘RLN’ by PTMC: (G) intrathyroidal - low risk; (H) posterior PTMC - high risk (modified from reference 15). PTMC = papillary thyroid microcarcinoma; RLN = recurrent laryngeal nerve.

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