Surgery vs Active Surveillance for Low-Risk Papillary Thyroid Carcinoma

  • Benjamin R. RomanEmail author
  • Ashok R. Shaha
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Low-risk papillary thyroid carcinomas (LR-PTC, tumors ≤1.5 cm) cause virtually no deaths, and are rapidly increasing in incidence due to overdiagnosis of subclinical disease. Herein we review the evidence base and the rationale behind a strategy of active surveillance of LR-PTC. We review natural history studies by Ito et al. and Tuttle et al., which to date form the backbone of literate on the subject. These studies provide good evidence supporting the hypothesis that LR-PTC is not a deadly disease even when observed. There is little additional evidence on patient reported outcomes (PROs, e.g. quality of life) and cost issues as they relate to an active surveillance strategy. We compare this body of literature to evidence regarding surgery for LR-PTC.

We conclude by highlighting the 2015 American Thyroid Association (ATA) Guideline recommendation against fine needle aspiration biopsy of thyroid nodules ≤1 cm without other concerning factors, and guideline recommendations regarding active surveillance. We recommend that patients who are diagnosed with LR-PTC be offered a choice of surgery or active surveillance, if there are no unfavorable or inappropriate features.


Low risk papillary thyroid carcinoma Papillary thyroid microcarcinoma Overdiagnosis Thyroidectomy Active surveillance Observation Quality of life Cost 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

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