Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?

What is the best surgical treatment for papillary thyroid microcarcinoma (PTMC)?

Background: Surgeons have debated whether to perform a total or hemithyroidectomy for PTMC, a carcinoma less than 1 cm in size. Historically, treatment was a total thyroidectomy, but the paradigm has shifted with recent guidelines from the American and British Thyroid Associations.

Study design: Retrospective chart reviews and database analyses.

Setting: Division of Head and Neck Surgery, University of California, Los Angeles; Anacapa Surgical Associates, Ventura, Calif.

Synopsis: A Mayo Clinic study in 1992 looked at 535 patients with PTMC treated over a 50-year period, noting a higher recurrence rate in those who underwent hemithyroidectomy. Multiple studies in the U.S. concurred and, in 2002, the British Thyroid Association and the Royal College of Physicians released guidelines recommending total thyroidectomy. Recently, the majority of studies have described PTMC as a low-grade malignancy that can be treated with hemithyroidectomy alone. However, prognostic indicators that may lead to more aggressive treatment of PTMC include extracapsular invasion, lymph node metastases, previous radiotherapy, age and aggressive histologic variants. In 2007 and 2009, respectively, the British Thyroid Association and the American Thyroid Association revised their guidelines to recommend thyroid lobectomy for PTMC. The authors of this review noted that no prospective randomized controlled trial has been conducted to compare the effect of lobectomy versus total thyroidectomy on survival and locoregional recurrence.

Bottom line: Although total thyroidectomy has been the treatment of choice historically, the American and British Thyroid Associations now recommend thyroid lobectomy for PTMC.

Citation: Wu AW, Nguyen C, Wang MB. What is the best treatment for papillary thyroid microcarcinoma? Laryngoscope. 2011;121(9):1828-1829.

—Reviewed by Sue Pondrom