Incidental multifocal papillary microcarcinomas of the thyroid: Is subtotal thyroidectomy combined with radioiodine ablation enough?

Clinical features and therapeutic outcomes of patients with papillary thyroid microcarcinomas and larger tumors

OBJECTIVE

The aim of this study was to identify clinical features and therapeutic outcomes of patients with papillary thyroid cancer (PTC) according to tumor diameter and evaluate the correlation of neck lymph node (LN) involvement of papillary thyroid microcarcinoma (PTMC) according to patients' age.

PATIENTS AND METHODS

We divided 467 patients into two groups according to tumor diameter: PTMC group (≤1 cm) and non-PTMC group (>1 cm). The clinical data were analyzed retrospectively. Thereafter, we divided the PTMC patients into three subgroups according to age: young subgroup (<45 years), middle subgroup (45-54 years), and old subgroup (≥55 years). A further study about clinical features, especially the neck LN involvement in three subgroups, was analyzed.

RESULTS

All patients received radioiodine ablation at least once. There were more patients with a single cancer lesion and cancer in the unilateral lobe, less number of neck LN involvement, fewer patients with neck lymph node metastasis (LNM), and more patients with Hashimoto's thyroiditis in PTMC group than in non-PTMC group. At the further evaluation, 58.03% patients maintained clinical remission, which was more in the PTMC group than in non-PTMC group. There was no significant difference in recurrence, but the disease-free survival rate of patients in the PTMC group was higher than in the non-PTMC group. In the PTMC group, the radioactive iodine curative ratio in younger patients is lower than that in the other two subgroups. Both the LNM and central LNM (CLNM) rates were significantly higher in young patients compared with older patients. In addition, the LNM-positive group had more male patients, larger tumor size, and higher thyroglobulin antibody level. Both LNM and the CLNM rates were significantly higher in the young subgroup than in the older subgroup. Young and middle age and extrathyroid extension were independent risk factors for neck LNM. Unlike LNM, young age, extrathyroid extension, and male sex were independent risk factors for CLNM.

CONCLUSION

Some PTMCs were less aggressive and the therapeutic outcomes of them were better than non-PTMC. Moreover, PTMCs in young patients were more aggressive, especially in LNM. Hence, clinicians should consider an individualized treatment according to tumor characteristics and age to achieve better therapeutic efficacy.

Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis

Background:

The clinicopathological characteristics and conclusive treatment modality for multifocal papillary thyroid microcarcinoma (mPTMC) have not been fully established.

Methods:

A retrospective study, systematic review, and meta-analysis were conducted to elucidate the clinicopathological significance of mPTMC. We investigated the multiplicity of 383 classical papillary thyroid microcarcinomas (PTMCs) and the clinicopathological significance of incidental mPTMCs. Correlation between tumor recurrence and multifocality in PTMCs was evaluated through a systematic review and meta-analysis.

Results:

Tumor multifocality was identified in 103 of 383 PTMCs (26.9%). On linear regression analysis, primary tumor diameter was significantly correlated with tumor number (R²=0.014, p=.021) and supplemental tumor diameter (R²=0.117, p=.023). Of 103 mPTMCs, 61 (59.2%) were non-incidental, with tumor detected on preoperative ultrasonography, and 42 (40.8%) were diagnosed (incidental mPTMCs) on pathological examination. Lymph node metastasis and higher tumor stage were significantly correlated with tumor multifocality. However, there was no difference in nodal metastasis or tumor stage between incidental and non-incidental mPTMCs. On meta-analysis, tumor multifocality was significantly correlated with tumor recurrence in PTMCs (odds ratio, 2.002; 95% confidence interval, 1.475 to 2.719, p<.001).

Conclusions:

Our results show that tumor multifocality in PTMC, regardless of manner of detection, is significantly correlated with aggressive tumor behavior.

Incidental and non-incidental thyroid microcarcinoma

There is no clear therapeutic approach for thyroid microcarcinoma (TMC). This may be as a consequence of recent observations that have reported biologically different types of TMC, which should be treated differently. The objective of the present study was to compare incidental TMC (ITMC) and non-incidental TMC (NITMC) in order to assess the differences in the incidence, diagnostic results, clinicopathological characteristics and surgical treatment. The study consisted of a retrospective chart review of 3,218 patients consecutively admitted and surgically treated in a single institution due to thyroid pathology. A total of 246 (7.64%) patients presented with a thyroid malignancy, and 97 (39.43%) of these individuals were diagnosed with TMC; 37 (38.14%) patients exhibited ITMC and 60 (61.86%) exhibited NITMC. All 37 (100.00%) patients with ITMC exhibited a papillary type of cancer. In the NITMC group, 1 (1.67%) patient presented with follicular microcarcinoma, 1 (1.67%) individual with papillary- and follicular-type microcarcinoma, 1 (1.67%) individual with medullary microcarcinoma, and the remaining 57 (95.00%) patients presented with papillary microcarcinoma. The number of younger patients (<45 years old) was higher in the NITMC group, but this difference was not significant (P=0.205). In all patients with ITMC, ultrasound-guided fine-needle aspiration biopsy did not reveal malignant processes. In the NITMC group, the number of larger tumors (>5 mm) was significantly higher compared with that in the ITMC group (P<0.001). ITMC was significantly associated with multinodular goiter (MNG) (P<0.001). Amongst the NITMC group, 18.33% of patients presented with cervical lymph node involvement (P<0.001). Overall, the incidence of TMC is high, and consists of ITMC and NITMC, although the prevalence of NITMC is higher than that of ITMC. The majority of ITMCs and NITMCs are composed of a papillary type of cancer. The majority of ITMCs have dimensions ≤5 mm in diameter and are significantly associated with MNG. In comparison with ITMC, NITMC more often presents with aggressive features such as cervical lymph node metastases, so the surgical approach to this tumor should be more radical.

Multifocal Papillary Thyroid Cancer Increases the Risk of Central Lymph Node Metastasis

BACKGROUND

Papillary thyroid cancer (PTC) is the most common thyroid malignancy, with a strong predilection for lymph node metastasis, most commonly to the central neck compartment (level VI). Few studies have evaluated lymph node metastasis in multifocal PTC, and the role of level VI dissection in the management of PTC remains controversial. This retrospective analysis evaluated the rate of level VI lymph node positivity in multifocal PTC, as compared with unifocal disease, in order to inform surgical decision making better.

METHODS

Patients with PTC who underwent total or hemi-thyroidectomy plus level VI lymph node dissection at the authors' institution between January 2008 and June 2014 were included (N=227). The number and laterality of PTC foci, lymphovascular invasion (LVI), extrathyroidal extension (ETE), and positive/total number of level VI lymph nodes were recorded. Fisher's exact test was used to determine univariate associations, and multivariate analysis was done by logistical regression.

RESULTS

There was an association between the number of PTC foci and level VI node positivity (p<0.001), with an odds ratio (OR) of 2.355 in patients with three or more tumor foci (p=0.026). The OR for central neck metastasis was 1.088 with each additional focus of PTC (p=0.018). The risk of level VI node positivity in the presence of one or two foci was only 19%, with no appreciable difference between one and two foci. This risk increased in the presence of between three and nine foci (38%), and 10 or more foci (88%). Level VI node positivity was associated with ETE (p<0.001), LVI (p<0.001), and size of the largest focus (p<0.001). There was no association between level VI lymph node positivity and male sex (p=0.089), bilaterality (p=0.276), or age (p=0.076).

CONCLUSIONS

There is a significant association between multifocal PTC and level VI lymph node positivity, increasing proportionally with the number of foci. These findings recognize multifocality as a sign of tumor aggressiveness, as evidenced by a higher propensity for lymph node metastasis.

Extensive bone metastases as the initial symptom of papillary thyroid microcarcinoma: A case report

A 53-year-old female patient presented with lumbar and pelvic pain. The ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography scintigraphy showed extensive bone destruction with hypermetabolic osteolysis, with increased ¹⁸F-FDG uptake. The histological examination of the pubic bone lesion revealed a metastatic tumor. Neither chemotherapy nor radiotherapy could control the condition. More than a year later, the patient underwent a total thyroidectomy with cervical lymph node clearance. The histological examination revealed a papillary thyroid microcarcinoma (PTMC) in the left lobe with capsular invasion. ¹³¹I treatment with thyroid hormone withdrawal followed. The ¹³¹I whole-body scintigraphy showed extensive uptake in the basic thyroid deposits, most bones and both lungs. Three months after the ¹³¹I treatment, the patient succumbed to cachexia. The present case indicated that not all PTMCs have excellent prognosis and that, despite being rare, clinically significant metastases can arise from a PTMC.

Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up

CONTEXT

There is controversy as to whether papillary thyroid microcarcinoma (PTMC) represents more than one disease entity with different outcomes, requiring different treatment.

OBJECTIVES

To compare characteristics, outcomes, and factors associated with prognosis of incidental and nonincidental PTMC.

SETTING AND DESIGN

Two reviewers performed searches of online databases (1966-2012), reference lists, and conference abstract books. Longitudinal studies of subjects >16 years old receiving any treatments for papillary thyroid cancer ≤10 mm in size were included. Two reviewers independently screened abstracts and articles, extracted data, and assessed quality of studies using National Institute of Clinical Excellence and PRISMA criteria.

RESULTS

Of 1102 abstracts identified, 262 studies were reviewed and 17 studies included, comprising 3523 subjects, with mean follow-up of 70 months and total follow-up of 21 329 person-years. This included 854 subjects with incidental PTMC (follow-up, 4800 person-years; mean tumor size, 4.6 mm [range 3.3-6.7 mm]) and 2669 nonincidental PTMC cases (follow-up, 16 529 person-years; mean tumor size, 6.9 mm [range 5.6-8.0 mm]). The recurrence rate in the incidental group (0.5%; 95% confidence interval [CI], 0-1%, P < .001) was significantly lower than that in the nonincidental group PTMC (7.9%; 95% CI, 5-11%), with an OR of recurrence of 14.7 (95% CI, 5.6-54.8, P < .001) for nonincidental PTMC, compared with incidental PTMC. Lymph nodes were involved in 80% (126/157) of recurrences. On meta-regression, age, sex, size, tumor multifocality, lymph node involvement, and treatment modality were not significantly associated with recurrence.

CONCLUSIONS

Our meta-analysis strongly suggests the existence of at least two distinct entities of PTMC. Incidental PTMC has different clinical characteristics and a much lower recurrence rate than nonincidental PTMC, suggesting that management protocols should be re-considered. Additional studies with standardized data collection are required to explore potential differences between subgroups of nonincidental PTMC.

Treatment for papillary thyroid microcarcinoma

Aim of the study

The treatment for papillary thyroid microcarcinoma (PTMC), which is a tumor measuring less than 1 cm, is still a subject of controversy. The aim of this study is to retrospectively evaluate the patients diagnosed with PTMC in terms of their clinical and histopathological features.

Material and methods

A total of 153 consecutive patients with PTMC were treated, and their clinical and histopathological characteristics were reviewed. The tumor diameter was observed to range from 1.0 mm to 10 mm (mean of 5.8 mm). Histologically, 138 (90.2%) cases of classical papillary carcinoma and 15 (9.8%) cases of the follicular variant were noted. Multicentric tumors were found in 37 (24.2%) patients, of whom 12 (7.8%) had more than one PTMC on the same side and 25 (16.3%) displayed bilateral PTMC.

Results

The proportions of capsular invasion and lymph node metastasis were 11.8% (18/153) and 48.1% (39/81), respectively. One patient showed distant metastasis during follow-up and died fifteen months after the operation. PTMC showed a high incidence of multifocality and lymph node metastasis in the level VI central compartment. The optimal surgical strategy for PTMC was total thyroidectomy and central compartment node dissection.

Conclusions

Frozen tissue sections should be made for the prompt diagnosis of PTMC in all the thyroid nodules, except when the malignant diagnosis was already confirmed by cytology.

Ultrasound findings of papillary thyroid microcarcinoma: a review of 113 consecutive cases with histopathologic correlation

Papillary thyroid microcarcinoma (PTMC) is a malignant thyroid tumor of less than 1 cm in size. Ultrasound (US) is the preferred imaging modality for PTMC. This study retrospectively evaluated the US results from 113 consecutive cases of PTMC with 127 nodules and correlated the results with the histopathologic findings. The results showed none of the PTMC nodules had a cystic element. Half of the PTMC nodules had a well-defined boundary and the remaining half had an ill-defined boundary. A percent (6.3%) of the nodules had a halo sign. Microcalcification was present in approximately half of the PTMC nodules. The cancerous tissue with a papillary structure was hypoechogenic and the amount of fibrous stroma determined whether the nodule echogenicity was heterogeneous or homogeneous. Heterogeneous echogenicity was associated with a fibrous stroma proportion of >20%. Only PTMC nodules with predominantly follicular structures containing a large proportion of colloid demonstrated isoechogenicity. Well-defined boundaries on US were associated with well-defined histologic margins, with or without the presence of an intact fibrous pseudo-capsule. A halo sign with a well-defined boundary detected by US was associated with the presence of an intact fibrous pseudo-capsule. Half of the PTMC nodules with ill-defined boundaries exhibited infiltration into the surrounding thyroid tissue, while the remaining half of the PTMC nodules with ill-defined boundaries on US presented irregular nodule margins by histology, rather than nodule infiltration. Psammoma bodies detected at a frequency ≥5 per ×200 microscopic field of view were detectable on US as microcalcifications.

Completion thyroidectomy: effect of timing on clinical complications and oncologic outcome in patients with differentiated thyroid cancer

BACKGROUND

Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial.

METHODS

Between January 1993 and December 2009, a total of 128 patients underwent completion thyroidectomy for differentiated thyroid carcinoma: papillary (n = 87) and follicular (n = 41). These patients were divided into five groups according to the time of the completion thyroidectomy after primary surgery (groups A, 1-3 days; B, 4-7 days; C, 1-7 weeks; D, 7-12 weeks; E, >3 months). Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 82.5 ± 17 months.

RESULTS

The overall rates of transient and persistent postoperative hypocalcemia were 7.0 and 3.1%, respectively. The rates of persistent hypocalcemia were significantly increased in groups B, C, and D in comparison to those in groups A and E (p < 0.003). The hypocalcemia rates were 7.1, 4.5, and 3.8% versus 0%, respectively. Transient or persistent vocal cord paresis was observed in eight (6.2%) and four patients (3.1%), respectively. The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups B, C, and D than in groups A and E (p < 0.003). The VCP rates were 7.1, 4.5, and 3.8% versus 0%, respectively. There was no significant difference regarding survival or recurrence among the five groups.

CONCLUSIONS

Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed either within 3 days or beyond 3 months after primary surgery.

Differences in the Form of Presentation between Papillary Microcarcinomas and Papillary Carcinomas of Larger Size

Papillary thyroid carcinomas (PTCs) with a diameter ≤1 cm are referred to as papillary microcarcinomas (PTMCs). The prognostic factors for PTMCs have not been defined. Different clinical and histopathologic variables were studied in 152 PTCs, including 74 PTMCs and 78 PTCs of larger size. We found that PTMCs are associated with less multifocality (P = .046) and bilaterality (P = .003), fewer lymphadenectomies (P < .001), and a higher rate of incidental tumours (P < .001). Moreover, patients with a low aggressive profile were significantly older than the remaining patients (54 ± 13.7 years versus 45.8 ± 13.1 years; P = .001). In conclusion PTMCs show significant differences compared to PTCs of larger size in the form of presentation. Furthermore, it is possible that the classic risk factors, which are well validated in PTCs, such as age, must be cautiously interpreted in the current increasing subgroup of PTMCs.

Impact of prostate cancer multifocality on its biology and treatment

Any focal therapy requires correct localization of the lesion; consequently, much effort is now devoted to accurate characterization of the spatial distribution of the tumor within the prostate. One of the greatest difficulties in the localization of prostate cancer is its frequent multifocality, but prostate cancer is unifocal in 13% to 43.7% of cases and unilateral in 19.2%. In cases of multifocality, it seems that the index tumor is the biologic driving force behind the malignant potential of prostate cancer. Not only is the Gleason score of the secondary nodes lower than that of the index node, but 80% of the secondary nodes are smaller than 0.5 cc and almost all extraprostatic extensions are associated with the largest cancers. While current evaluation with 12 to 18 core biopsies may be adequate to determine the index lesion, transperineal three-dimensional mapping biopsy of the prostate should be undertaken if greater accuracy is needed.

Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients

BACKGROUND

The management of thyroid papillary microcarcinoma (PMC) is controversial. Total thyroidectomy, thyroid lobectomy/isthmectomy, and even no treatment have been proposed. We investigated the clinical course and prognostic factors for disease recurrence and distant metastasis in 445 patients with PMC.

METHODS

Data from 445 patients diagnosed with PMC in the period from 1978 to 2003 were reviewed and analyzed. Total thyroidectomy was performed in 404 patients and loboisthmusectomy in 41. Neck dissection took place in 226 patients (49.7%), with 166 of only the central compartment and 60 of both the central and lateral compartments. Radioiodine ((131)I) ablation treatment was given to 389 patients.

RESULTS

Median tumor size was 7 mm (range 1-10 mm). PMC was multifocal in 156 cases (35%) and bilateral in 60 cases (13.5%). Extrathyroidal tumor extension (pT3) and neck lymph node metastasis (pN1) were present in 133 (30%) and 182 (40.9%) patients, respectively. Capsular invasion without extrathyroidal tumor extension was observed in 39 (8.7%) patients. Mean follow-up was 5.3 (range 1-26) years. Seventeen (3.8%) patients had recurrence or persistence of disease: neck recurrence (NR) in 12 (2.7%), distant metastasis (DM) in four (0.9%), NR + DM in one (0.2%). One patient (0.2%) died of the disease. Capsular invasion, extrathyroidal tumor extension (pT3), and neck lymph node metastasis at presentation (pN1) were the only independent risk factors for NR and/or DM occurrence (p < 0.05). Patients not showing these features, who were treated with loboisthmusectomy only, never experienced disease recurrence.

CONCLUSION

Total thyroidectomy seems advisable in PMC with extrathyroidal extension and neck lymph node metastasis at presentation. Capsular invasion without extrathyroidal extension may suggest aggressive tumor behavior and require radical treatment.

'Aggressive papillary' thyroid microcarcinoma

The objective of this study is to highlight the fact that papillary thyroid microcarcinoma can be aggressive, requiring therapeutic management similar to that of other differentiated thyroid cancers. This 8-year retrospective study concerned 187 surgical patients managed in an ENT and Head and Neck surgery department for thyroid cancer. 65 patients were found to have papillary microcarcinoma. 41 microcarcinomas were considered to be aggressive because of the presence of several risk factors such as larger than 5 mm, multifocal microcarcinomas, capsular effraction, vascular embolus, tumour extension beyond the thyroid parenchyma and metastatic lymphadenopathy. All patients with aggressive papillary microcarcinoma were treated by total thyroidectomy and (131)I. Ipsilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in ten patients, ipsilateral cervical lymph node dissection was performed in six patients and bilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in three patients. No recurrence or metastasis was observed (follow-up ranging from 6 months to 8 years). The optimal management of thyroid papillary microcarcinoma is still controversial. "Aggressive" papillary thyroid microcarcinoma is not rare and may justify aggressive treatment depending on the presence or absence of prognostic risk factors.

Management of low-risk differentiated thyroid cancer

OBJECTIVE

To summarize the definitions of and management recommendations for low-risk thyroid cancer made by the American and European Thyroid Associations and synthesize this information with the recent literature, including systematic evaluations of tumor staging systems guiding therapy.

METHODS

The American Thyroid Association and European Thyroid Association guidelines were compared and pertinent literature since 2005 was reviewed.

RESULTS

Of papillary thyroid microcarcinomas (PTMC), up to 50% breach the thyroid capsule, 64% have lymph node metastases, up to 43% are multifocal, and as many as 2.8% have distant metastases. Locoregional and distant recurrences are, respectively, as high as 5.9% and 1.5%. As many as 1 in 4 patients with a papillary thyroid carcinoma 1.5 cm or smaller develop persistent disease. Cancer-related mortality rates are usually less than 1%, but are as high as 2% in some reports. Tumor staging systems are too inaccurate to guide therapy.

CONCLUSION

It is unlikely that many patients will forgo treatment after understanding their risk, especially when total thyroidectomy and radioiodine (131I) therapy can reduce the PTMC recurrence or persistence disease rate to zero. Preoperatively diagnosed PTMC should be treated with total or near-total thyroidectomy, regardless of tumor size. For very low-risk patients with unifocal PTMC smaller than 1 cm that is removed by chance during surgery to treat benign thyroid disease, lobectomy alone without 131I therapy may be sufficient therapy if there are no concerning histologic features and no tumor extension beyond the thyroid, metastases, history of head and neck irradiation, or positive family history--any of which requires total or near-total thyroidectomy and remnant ablation with 30 mCi.

Treatment for microcarcinoma of the thyroid--clinical experience

AIMS AND BACKGROUND

Papillary microcarcinoma of the thyroid is a specific subgroup of papillary thyroid carcinoma (PTC) and account for up to 30% of all PTC. According to the World Health Organization, papillary microcarcinoma of the thyroid (PMC) is defined as a papillary thyroid carcinoma measuring <or=10 mm in the greatest dimension. The relative rate of PMC is increasing in patients with differentiated thyroid carcinoma (DTC) mainly due to more frequent use and improvement of ultrasonography and fine-needle aspiration biopsy, and also more accurate histopathological examination of surgical specimens. The high incidence of PMC found in autopsy studies (up to 35%) suggests that most of them have a benign behavior. The locoregional recurrence has been reported in up to 20% of PMC patients and several cases of distant metastases have also been described. The 'ideal' therapeutic approach in PMC patients remains a subject of debate among endocrinologists and surgeons. Treatment of PMC in different departments varies from partial thyroidectomy to total thyroidectomy and radioiodine treatment. The main question in this group of patients is "How should PMC patients be treated?" The aim of this study was to investigate retrospectively the frequency and clinical behavior of PMC of the thyroid gland in our department and also to identify the optimal treatment of this group of patients.

MATERIALS AND METHODS

For this retrospective study, we evaluated 120 patients with PMC in our department (between 1997 and 2005). The mean age of patients at diagnosis was 43 +/- 13 years (range 17-67 years). The female to male ratio was 87.5% (105 females, 15 males). The mean follow-up period of patients in this study was 45 months (16-84 months). Surgical treatment of patients with PMC in our department consisted of a bilateral total thyroidectomy in 25 patients (21%), and a bilateral near total thyroidectomy in 95 patients (79%). In the evaluation of our patients, multifocal PMC had a relative frequency of 15% (18/120 patients). The patients were informed about the different therapeutic strategies and the possible necessity for more frequent radioiodine treatment to eliminate thyroid remnants. All of the patients in our retrospective study had radioiodine (RAI) ablation therapy for residual thyroid tissue.

RESULTS

All patients received an RAI treatment dose which ranged from 75-150 mCi (2.7-5.5 GBq). Our criteria for ablation are as follows: negative I-131 WBS and very low serum Tg levels (<1 ng/mL). In 112/120 patients (93.3%), the thyroid remnant was ablated with a single dose of I-131 75-150 mCi (2.7-5.5 GBq). A second radioiodine treatment was necessary in 8 patients (7%), because of locoregional recurrence (required mean cumulative doses of 8.2-11 GBq I-131). Locoregional reccurence occurred in 2 patients with unifocal tumor, without capsular invasion or lymph node metastases and in 6 patients with multifocal tumor and/or in patients with capsular invasion or lymph node metastases. After a second radioiodine treatment, all of these 8 patients were ablated. All 120 patients remained free from disease (negative I-131 whole body scan, unmeasurable thyroglobulin levels) after a median follow-up period of 45 months and there was no recorded disease-related mortality.

CONCLUSION

The treatment of patients with PMC should be no different from the treatment of patients with PTC, and thyroidectomy followed by radioiodine therapy may be a possible option for treatment of papillary microcarcinoma.