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Annals of Surgical Oncology

, 16:3132 | Cite as

Papillary Thyroid Microcarcinomas: Big Decisions for a Small Tumor

  • Megan Rist Haymart
  • Max Cayo
  • Herbert Chen
Endocrine Tumors

Abstract

Background

The clinical significance of papillary thyroid microcarcinoma (PTMC) is debated, and therefore the rise in incidence of PTMC creates management dilemmas. The following study evaluates factors influencing decisions to treat.

Materials and Methods

Between 1994 and 2007, 1361 patients underwent thyroid surgery at a single institution. Of these patients, 107 were diagnosed with PTMC. The type of surgical intervention, likelihood of referral to an endocrinologist, use of radioactive iodine, and administration of suppressive doses of levothyroxine (LT4) were analyzed in relation to patient and tumor characteristics.

Results

Multifocality and larger size were predictive of which patients underwent total thyroidectomy on multivariable logistic regression (P = .004 and P = .001, respectively). Larger mean tumor size, 0.62 ± 0.004 versus 0.34 ± 0.006 cm, was independently associated with increased likelihood of endocrine referral (P = .029). Multifocality, diagnosis via FNA preoperatively, larger mean size of PTMC, and endocrine referral were independently associated with increased likelihood of receiving radioactive iodine (RAI). On multivariable analysis, only total thyroidectomy and endocrine referral were independently associated with treatment with suppressive doses of LT4 (P = .001 and .001, respectively). In the 47 patients with unifocal PTMC <0.8 cm diameter, the mean size of tumor focus was larger in the subgroup undergoing total thyroidectomy (P = .004). Surprisingly, in these very low risk PTMC patients, the likelihood of RAI for remnant ablation was independently associated with younger patient age (P = .029). In the subgroup with unifocal <0.8 cm disease, the mean age of patients receiving RAI was 34 ± 3.3 years versus 48 ± 2.3 years in those not receiving RAI (P = .003).

Conclusions

The decision tree in the management of PTMC is beginning at the time of surgery, and referral to endocrinology is associated with a more aggressive course. Younger age is predictive of RAI administration in the lowest-risk PTMC patients.

Keywords

Total Thyroidectomy Papillary Thyroid Cancer Radioactive Iodine Follicular Adenoma Completion Thyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The Academic Oncologist K12 Training Grant through the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center supports Megan R. Haymart’s research, CA K12 087718. Herb Chen is funded by NIH NCI-RO1CA109053 and NIH NCI-R01CA121115. We thank Jesse Quinn and Ben Hofeld for their role in data collection. The authors have nothing to disclose.

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Megan Rist Haymart
    • 1
    • 2
    • 4
  • Max Cayo
    • 3
  • Herbert Chen
    • 3
    • 4
  1. 1.Division of Metabolism, Endocrinology, and Diabetes (MEND)University of MichiganMichiganUSA
  2. 2.Division of Hematology/OncologyUniversity of MichiganMichiganUSA
  3. 3.Section of Endocrine Surgery, Department of SurgeryUniversity of WisconsinMadisonUSA
  4. 4.University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterUniversity of WisconsinMadisonUSA

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