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Table 3 Summary of ATA, BTA and ETA PTMC management recommendations

From: Current management of papillary thyroid microcarcinoma in Canada

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: 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