From: Current management of papillary thyroid microcarcinoma in Canada
ATA | Â | BTA | ETA |
---|---|---|---|
Investigate | > 5 mm if: | Can be managed by primary care physician if: | FNAC only if: |
1.suspicious US findings (microcalcifications; hypoechoic; increased nodular vascularity; infiltrative margins; taller than wide on transverse view). | 1. non-palpable, | 1. suspicious finding on US (solid hypoechoic with microcalcifications), | |
2. history of head and neck radiation, or history of thyroid cancer in one or more first-degree relatives, | 2. incidentally found, | 2. personal history | |
3. abnormal cervical lymph nodes | 3. no concerning features | ||
Surgery | Lobectomy sufficient if: 1.no associated lymphadenopathy, | Lobectomy sufficient if: | Lobectomy sufficient if: |
2. no history of head and neck radiation or positive family history of thyroid cancer, | 1. lymph node negative and followed by levothyroxine therapy, | 1. no evidence or nodal or distant metastasis, | |
3. low risk, unifocal, and intrathyroidal nodule | 2. no multifocality, | 2. no history of previous radiation exposure, | |
3. no extrathyroidal spread, | 3. multifocality, | ||
4. no family disease, | 4. extrathyroidal extension, | ||
5. no metastasis, | 5. vascular invasion, | ||
6. no vascular invasion, | 6. unfavorable histology | ||
7. no contralateral disease | |||
RAI | Recommended if: distant metastasis or gross extrathyroidal extension. | Omit if : | No indication if: |
Not recommended if: | 1. Unifocal, | 1. complete surgery, | |
1. unifocal and no high risk features, | 2. N0 M0, | 2. favorable histology, | |
2. multifocal with all nodules < 1 cm. | 3. no extension beyond the thyroid, | 3. N0 M0, | |
Selective use if regional lymph node metastasis | 4. favorable histology, | 4. no extrathyroidal extension | |
5. complete surgery |