A Case of a Small (1–2 cm) Papillary Thyroid Cancer in a Young Patient: Lobectomy Versus Total Thyroidectomy

Abstract

Small papillary thyroid carcinomas are very common and rarely threaten any patient’s long-term survival. The majority of patients with tumors below 2 cm in size falls into the American Thyroid Association low-risk group and can be effectively treated and followed using a variety of strategies. The tumor features that increase the risk of further problems with thyroid cancer (death or recurrence) include vascular invasion within the tumor or invasion of tumor into tissues outside of the thyroid capsule, gross lymph node metastases, BRAF V600E mutation in the tumor, or aggressive histologic features. The findings during treatment that increase the patient’s risk include the inability to completely resect the tumor due to local invasion or the presence of local or distant metastases on postoperative radioiodine scan or other imaging modalities. The clinical challenge is to identify the minority of patients with small tumors and higher-risk disease, in order to focus the more aggressive therapeutic strategies (total thyroidectomy, radioiodine therapy, and TSH suppression) on that group.