Column 8. The Controversy Regarding the Extent of Thyroidectomy for Papillary Carcinoma and Actual Practice in Japan
There is a significant difference regarding the initial treatment for papillary carcinoma between foreign countries and Japan. In guidelines from Western countries, total thyroidectomy is recommended for most patients with papillary carcinoma and ablation of the remnant thyroid by administrating RAI followed by lifetime TSH suppression by administering levothyroxine is regarded as the standard treatment. In contrast, in Japan, limited thyroidectomy (lobectomy or subtotal thyroidectomy) is widely adopted, especially for low-risk papillary carcinoma, after preoperative investigation of primary lesions and lymph node metastasis on ultrasonography. RAI ablation is only occasionally performed.