Thyroid microcarcinoma approach

AIM: To optimize thyroid microcarcinoma approach, through a retrospective examination of Authors’ experience and literature review. MATERIALS: Characteristics, treatment and outcomes of patients affected with thyroid microcarcinoma were examined: among 1733 patients operated on for thyroid diseases at Endocrine Surgery Unit of San Paolo Hospital in Milan, from 2001 to 2011, 104 (6.0%) resulted affected with microcarcinoma. Twenty (19.2%) had pre-operative and 84 (80.8%) post-operative diagnosis, 11 with (N+) and 93 without (N0) lymph node metastasis. Eighty-five patients underwent total thyroidectomy, 11 (N+) total thyroidectomy with lymphoadenectomy and 8 lobectomy, 2 radicalized in thyroidectomy. All patients underwent Levo-thyroxine suppressive therapy, 25 (24.0%) 131I ablation. Differences between N0 and N+ patients were researched. RESULTS: Neither recurrences nor death at a mean follow-up of 5.6 years. Tumour was multifocal and in thyroid with no other diseases in N+, in a greater rate than in N0 patients. DISCUSSION: Microcarcinoma generally has an indolent course, but sometimes it presents with nodal metastasis. For this reason its treatment in literature is still largely debated. CONCLUSION: In cases of pre-operative diagnosis of microcarcinoma without lymph node metastasis, we propose total thyroidectomy; otherwise, total thyroidectomy with lymphoadenectomy. In cases of post-operative diagnosis, after a partial resection, only selected cases on the basis of patients’ and tumour features require a completion total thyroidectomy. We propose Levo-thyroxine suppressive therapy to all patients, 131I ablation in cases of lymphatic metastasis and only in selected cases without metastasis, on the basis of patients’ and tumour aspects (age, sex, histological variant, multifocality).