What is the Best Treatment for Papillary Thyroid Microcarcinoma?

Background

There has been substantial recent debate over the best surgical treatment for papillary thyroid microcarcinoma (PTMC), defined as a carcinoma less than 1 cm in size. As the incidence of patients with these subcentimeter tumors increases, the question of whether to peform a total versus a hemithyroidectomy for these lesions has become increasingly important.

Historically, treatment of any thyroid malignancy entailed total thyroidectomy both for eliminating tumor surgically and for clearing normal thyroid tissue prior to post-operative radioactive iodine ablation. This paradigm has slowly shifted with recent guidelines put forth by the American Thyroid Association in 2009 espousing conservative management of PTMC with hemithyroidectomy alone. However, as demonstrated by a recent survey study by these authors, clinical practice

in the surgical community is more mixed, with a significant minority of surgeons (30%) believing total thyroidectomy to be the appropriate treatment.

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