A 35-year-old woman undergoes total thyroidectomy for multinodular goiter. Final histology reveals an incidental 6 mm papillary thyroid microcarcinoma, classic variant, unifocal, with negative margins and no lymphovascular invasion. No lymph nodes were removed. According to ATA guidelines, what is the recommended further management?

• A TSH suppression therapy alone with close surveillance ✓
• B Radioactive iodine ablation with 150 mCi
• C Completion central neck dissection followed by radioactive iodine
• D External beam radiotherapy to the neck

Explanation

An incidental papillary thyroid microcarcinoma under 1 cm, unifocal, classic variant, with negative margins and no adverse features (lymphovascular invasion, extrathyroidal extension, nodal disease) is classified as ATA low risk. No further surgery or radioactive iodine is indicated. Management consists of TSH suppression to 0.5 to 2 mU/L and surveillance with neck ultrasound. The excellent prognosis of such lesions means no additional therapy improves outcomes. Radioactive iodine and completion surgery are overtreatment in this scenario.

Reference: American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer, 2015 ed.

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Written and medically reviewed by the StethoPrep medical team.