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Papillary Thyroid Carcinoma Treatment & Management

  • Author: Keith M Baldwin, DO; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
Updated: Oct 12, 2015

Approach Considerations

Surgery is the definitive management of papillary thyroid cancer. Approximately 4-6 weeks after surgical thyroid removal, patients may have radioiodine therapy to detect and destroy any metastasis and residual tissue in the thyroid.

External beam radiotherapy has been used as adjuvant therapy in patients with papillary thyroid cancer who were older than 45 years and had locally invasive disease. Some improvements in 10-year survival rates have been reported with this approach.

Patients require lifelong thyroid hormone replacement therapy, especially after total thyroidectomy. Treatment consists of levothyroxine in a dosage of 2.5-3.5 mcg/kg/d.

For summarized information on treatment, see Thyroid Cancer Treatment Protocols.


Surgical Care

Surgery is the definitive management of thyroid cancer. Various types of operations may be performed, ranging from lobectomy with isthmectomy to total thyroidectomy.

Lobectomy with isthmectomy is the minimal operation for a potentially malignant thyroid nodule. It is an option for patients younger than 40 years who have papillary thyroid carcinoma nodules that are smaller than 1 cm, well-defined, minimally invasive, and isolated. However, an important consideration in considering this approach is that approximately 10% of patients who have had only a lobectomy develop a recurrence in the contralateral lobe, and residual tissue has the potential to dedifferentiate to anaplastic cancer.

Subtotal thyroidectomy is a near-total thyroidectomy. The argument for this form of surgical intervention is that total thyroidectomy does not improve long-term prognosis, and subtotal thyroidectomy has a lower incidence of complications (eg, hypoparathyroidism, superior and/or recurrent laryngeal nerve injury) than total thyroidectomy.

Total thyroidectomy

Total thyroidectomy (removal of all thyroid tissue but preservation of the parathyroid glands) is commonly performed for patients with papillary carcinoma who are older than 40 years and in any patient with bilateral disease. In addition, total thyroidectomy is used in most patients with a thyroid nodule and a history of irradiation.

National Comprehensive Cancer Network guidelines recommend total thyroidectomy for patients who meet any of the following criteria[7] :

  • Radiation history
  • Known distant metastases
  • Bilateral nodularity
  • Extrathyroidal extension
  • Tumor > 4 cm in diameter
  • Cervical lymph node metastases
  • Poorly differentiated tumor

Total thyroidectomy is considered by many to be the surgical treatment of choice for papillary tumors of the thyroid, for a number of reasons. Papillary foci involving both lobes are found in some 60-85% of patients. About 5-10% of patients who have had a lobectomy develop recurrences in the remaining lobe. Also, at 20 years after initial surgery, patients who had undergone total thyroidectomy had a recurrence rate of 8%, whereas those who had received lobectomy only had a recurrence rate of 22%. Survival rates were, however, comparable.

Total thyroidectomy also facilitates earlier detection and treatment of recurrent or metastatic carcinoma. This surgical option is mandatory in patients with papillary carcinoma discovered on postoperative histology (ie, if a very well-differentiated tumor is discovered) after a lobectomy, with or without isthmectomy.

When the primary tumor spreads outside the thyroid and involves adjacent vital organs (eg, larynx, trachea, esophagus), these organs are preserved at the first surgical approach. However, the surrounding soft tissues, including the muscles and involved areas of the trachea and/or esophagus, may be sacrificed if they are directly involved with the differentiated thyroid carcinoma and local resection is feasible.

Surgical techniques include video-assisted and robotic-assisted thyroidectomy.[37, 38] Video-assisted thyroidectomy is rarely used to treat thyroid cancer. A study by Lee et al found that the application of robotic technology to endoscopic thyroidectomy may overcome the limitations of conventional surgery, in a patient population where neck incision is considered culturally averse. However, additional complications such as brachial plexus injury may occur with this technique.[39]

Central neck dissection

The routine addition of central neck dissection to total thyroidectomy has been debated over the years. Advocates cite a lower risk of later reoperation, since reoperations for recurrence can lead to higher rates of recurrent nerve injury. Critics cite the fact the upfront recurrent nerve injury rate may be higher and that no survival benefit has been demonstrated over total thyroidectomy alone.In a retrospective cohort study of 812 patients with papillary thyroid carcinoma, including 102 who underwent total thyroidectomy with elective central neck dissection and 478 who underwent total thyroidectomy alone, elective central neck dissection increased the risk for complications, but did not decrease local recurrence rates.[40]

A study by Roh et al found that subclinical metastases are highly prevalent in the ipsilateral central neck of patients with papillary thyroid carcinoma. The study also revealed that although contralateral central metastases are uncommon, they are associated with ipsilateral central metastases. The authors conclude that these findings may suggest the necessity and extent of prophylactic unilateral or bilateral central lymph node dissection.[41]

A study by Popadich et al found that the addition of routine central lymph node dissection in patients with cN0 papillary thyroid carcinoma reduced the need for reoperation in the central compartment and was associated with lower postoperative thyroglobulin levels.[42]


Surgical treatment of thyroid cancer may cause complications, partly because of the variable anatomy of the neck. These possible complications include the following:


Radioiodine Therapy

Approximately 4-6 weeks after surgical thyroid removal, patients may have radioiodine therapy to detect and destroy any metastasis and residual tissue in the thyroid. The decision for radioactive iodine depends on the size of the tumors removed, the prognostic features (eg, lymphovascular invasion) and the individual endocrinologist’s level of aggressiveness and interpretation of the literature.

After thyroidectomy, patients are given thyroid replacement therapy for approximately 4-6 weeks. Thyroid replacement is then discontinued, to induce a hypothyroid state and promote high serum thyroid-stimulating hormone (TSH) levels.

A diagnostic dose of radioiodine (131 I or123 I) is then given, and a whole-body scintiscan is performed to detect any tissue taking up radioiodine. If any normal thyroid remnant or metastatic disease is detected, a therapeutic dose of131 I is administered to ablate the tissue. The patient is then placed back on thyroid hormone replacement (levothyroxine) therapy.

Therapy is administered until radioiodine uptake is completely absent. Radioiodine treatment may be used again 6-12 months after initial treatment of metastatic disease, for cases in which disease recurs or has not fully responded.

Some patients have elevated stimulated thyroglobulin concentrations after reoperation for recurrent or persistent papillary thyroid cancer. Yim and colleagues found that in such patients, adjuvant radioiodine therapy resulted in no significant differences compared with no additional radioiodine therapy.[43]

Patients receiving radioiodine therapy need to follow radiation precautions, to maintain the safety of themselves, their familes, and the public. The American Thyroid Association Taskforce on Radioiodine Safety released recommendations to help guide physicians and patients in safe practices after treatment, including reminders in the form of a checklist.[44]


Radioiodine administration may have several consequences, including the following:

  • Radiation thyroiditis and transient thyrotoxicosis in patients with simple lobectomy
  • Sialoadenitis because radioiodine is taken up by the salivary glands
  • Nausea, anorexia, and headache (uncommon)
  • Pulmonary fibrosis in patients with large lung metastases
  • Brain edema in patients with brain metastases (may be prevented by glucocorticoid therapy)
  • Permanent sterility and transient oligospermia or menstrual irregularities
  • Teratogenesis and spontaneous abortions
  • A small increase in the risk for leukemias (in particular, acute myeloid leukemia [45] ) or breast and bladder carcinomas

Because radioiodine treatment may cause either teratogenesis or spontaneous abortions, patients should delay pregnancy for at least 1 year after radioiodine treatment.


Treatment of Advanced Disease

A study by Heilo et al determined that ultrasonography-guided percutaneous ethanol injections were an excellent alternative to surgery in patients with a limited number of neck metastases from papillary thyroid carcinoma. The authors suggest that this strategy could replace “berry picking” surgery.[46]

In patients with stage T4 disease, external beam radiation therapy (EBRT) may be performed to control local tumor growth in areas such as the neck, lungs, mediastinum, bone, and central nervous system. Radiation therapy may be indicated when a large, unresectable tumor is present and the uptake of radioiodine is limited, or when intractable bone pain exists. The American College of Radiology recommends that EBRT use of EBRT for thyroid cancer be considered on a case-by-case basis, as it has not been tested in well-designed, randomized, controlled trials.[47]

Chemotherapy with cisplatin or doxorubicin has limited efficacy, producing occasional objective responses (generally for short durations), and high toxicity. Chemotherapy may be considered in symptomatic patients with recurrent or advancing disease, and it may improve the quality of life in patients with bone metastases. However, a standard protocol for chemotherapeutic management has not been developed for these patients.

Novel agents are under active investigation as options for systemic therapy (eg, axinitib, sorafenib).[48] The American College of Radiology recommends encouraging patients with metastatic thyroid cancer that is not iodine avid to enroll in clinical trials of these agents.[47]

A discussion of recently available targeted therapies for use in advanced differentiated thyroid cancer no longer responsive to radioablation may be found in the Chemotherapy section of Follicular Thyroid Carcinoma.



Consult an otolaryngologist, especially in thyroid patients who have voice disturbances. Systematic psychotherapeutic intervention may be very helpful.


Long-term Monitoring

Repeat the radioiodine scintiscan 6-12 months after ablation and every 2 years thereafter. Before the scan, levothyroxine must be withdrawn for approximately 4-6 weeks to maximize thyrotropin stimulation of the any remaining thyroid tissue.

At 6 and 12 months after the cancer treatment (medical or surgical), any patient with a history of papillary thyroid carcinoma require follow-up monitoring that includes the following:

  • Complete physical examination
  • Thyroid-stimulating hormone (TSH) and thyroglobulin measurement
  • Antithyroglobulin antibodies titer

Continue to evaluate thyroglobulin serum levels every 6-12 months for at least 5 years. Consider a level greater than 20 ng/mL, after TSH suppression, to be abnormal. A rise in the thyroglobulin level is consistent with recurrence of thyroid cancer. A study by Brassard et al found that thyroglobulin measurements allow prediction of long-term recurrence with excellent specificity. TSH stimulation may be avoided when thyroglobulin levels measured 3 months after ablation are less than 0.27 ng/mL during levothyroxine treatment.[49]

Perform thyroid hormone suppression tests in all patients who have undergone total thyroidectomy and in all patients who have had radioactive ablation of any remaining thyroid tissue. Individualize the degree of suppression to avoid complications, such as subclinical hyperthyroidism.

A meta-analysis demonstrated that an undetectable serum thyroglobulin finding during thyroid hormone suppression of TSH is often misleading. Patients with endogenous subclinical hyperthyroidism have an increased risk of cardiovascular disease and dysrhythmia.[50] Accordingly, the authors propose a new surveillance guideline for patients who have undergone total or near-total thyroidectomy and radioactive iodine ablation and have no clinical evidence of residual tumor with a serum thyroglobulin level less than 1 mcg/L during thyroid hormone suppression of TSH.

Subclinical hypothyroidism may also occur. However, the clinical significance of subclinical hypothyroidism, and the benefits of treating it, remain uncertain.[51, 52]

Guidelines from the American Association of Clinical Endocrinologists (AACE) and the American Association of Endocrine Surgeons include recommendations for follow-up in patients with thyroid carcinoma.[53]

Patients require lifelong thyroid hormone replacement therapy, especially after total thyroidectomy. Treatment consists of levothyroxine in a dosage of 2.5-3.5 mcg/kg/d. A patient who has had a thyroidectomy without parathyroid preservation requires vitamin D and calcium supplementation for life.

Contributor Information and Disclosures

Keith M Baldwin, DO IMPH, Assistant Professor of Surgery, Boston University School of Medicine; Endocrine and Surgical Oncologist, Department of General Surgery, Roger Williams Cancer Center

Keith M Baldwin, DO is a member of the following medical societies: American College of Surgeons, Society of Surgical Oncology, American Association of Endocrine Surgeons, Americas Hepato-Pancreato-Biliary Association, Society of International Humanitarian Surgeons/Surgeons OverSeas (SOS)

Disclosure: Nothing to disclose.


Andrew Scott Kennedy, MD Physician-in-Chief, Radiation Oncology

Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Society for Radiation Oncology, Radiological Society of North America, Americas Hepato-Pancreato-Biliary Association, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Lodovico Balducci, MD Professor, Oncology Fellowship Director, Department of Internal Medicine, Division of Adult Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine

Lodovico Balducci, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians, American Geriatrics Society, American Society of Hematology, New York Academy of Sciences, American Society of Clinical Oncology, Southern Society for Clinical Investigation, International Society for Experimental Hematology, American Federation for Clinical Research, American Society of Breast Disease

Disclosure: Nothing to disclose.


Silvia Gagliardi, MD Consulting Staff, Department of Surgery, Medical Center Vita, Italy

Disclosure: Nothing to disclose.

  1. Wreesmann VB, Ghossein RA, Hezel M, et al. Follicular variant of papillary thyroid carcinoma: genome-wide appraisal of a controversial entity. Genes Chromosomes Cancer. 2004 Aug. 40(4):355-64. [Medline].

  2. Wada N, Sugino K, Mimura T, Nagahama M, Kitagawa W, Shibuya H, et al. Treatment Strategy of Papillary Thyroid Carcinoma in Children and Adolescents: Clinical Significance of the Initial Nodal Manifestation. Ann Surg Oncol. 2009 Sep 24. [Medline].

  3. Clayman GL, Shellenberger TD, Ginsberg LE, Edeiken BS, El-Naggar AK, Sellin RV, et al. Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck. 2009 Sep. 31(9):1152-63. [Medline].

  4. Rosenbaum MA, McHenry CR. Contemporary management of papillary carcinoma of the thyroid gland. Expert Rev Anticancer Ther. 2009 Mar. 9(3):317-29. [Medline].

  5. Pelizzo MR, Merante Boschin I, Toniato A, Pagetta C, Casal Ide E, Mian C, et al. Diagnosis, treatment, prognostic factors and long-term outcome in papillary thyroid carcinoma. Minerva Endocrinol. 2008 Dec. 33(4):359-79. [Medline].

  6. Thyroid Carcinoma Task Force. AACE/AAES Medical/Surgical Guidelines for Clinical Practice: Management of Thyroid Carcinoma. AACE Guidelines. Available at Accessed: October 8, 2015.

  7. NCCN Clinical Practice Guidelines in Oncology. Thyroid carcinoma: Version 2.2014. National Comprehensive Cancer Network. Available at Accessed: October 8, 2015.

  8. Legakis I, Syrigos K. Recent advances in molecular diagnosis of thyroid cancer. J Thyroid Res. 2011. 2011:384213. [Medline]. [Full Text].

  9. Prescott JD, Zeiger MA. The RET oncogene in papillary thyroid carcinoma. Cancer. 2015 Mar 2. [Medline].

  10. Wasenius VM, Hemmer S, Karjalainen-Lindsberg ML, et al. MET receptor tyrosine kinase sequence alterations in differentiated thyroid carcinoma. Am J Surg Pathol. 2005 Apr. 29(4):544-9. [Medline].

  11. Musholt TJ, Musholt PB, Khaladj N, et al. Prognostic significance of RET and NTRK1 rearrangements in sporadic papillary thyroid carcinoma. Surgery. 2000 Dec. 128(6):984-93. [Medline].

  12. Mathur A, Moses W, Rahbari R, et al. Higher rate of BRAF mutation in papillary thyroid cancer over time: a single-institution study. Cancer. 2011 Oct 1. 117(19):4390-5. [Medline]. [Full Text].

  13. Xing M, Alzahrani AS, Carson KA, Viola D, Elisei R, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA. 2013 Apr 10. 309 (14):1493-501. [Medline]. [Full Text].

  14. Li Z, Franklin J, Zelcer S, Sexton T, Husein M. Ultrasound surveillance for thyroid malignancies in survivors of childhood cancer following radiotherapy: a single institutional experience. Thyroid. 2014 Dec. 24 (12):1796-805. [Medline].

  15. Port M, Boltze C, Wang Y, et al. A radiation-induced gene signature distinguishes post-Chernobyl from sporadic papillary thyroid cancers. Radiat Res. 2007 Dec. 168(6):639-49. [Medline].

  16. Ronckers CM, McCarron P, Engels EA, et al. New Malignancies Following Cancer of the Thyroid and Other Endocrine Glands. Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. No. 05-5302. Bethesda, MD: NIH Publ.; 2006. 375-395. [Full Text].

  17. Williams ED, Abrosimov A, Bogdanova T, Demidchik EP, Ito M, LiVolsi V, et al. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer. 2004 Jun 1. 90 (11):2219-24. [Medline]. [Full Text].

  18. Negri E, Dal Maso L, Ron E, et al. A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors. Cancer Causes Control. 1999. 10(2):143-155. [Medline].

  19. Franceschi S, Preston-Martin S, Dal Maso L, et al. A pooled analysis of case-control studies of thyroid cancer. IV.Benign thyroid diseases. Cancer Causes Control. 1999. 10(6):583-595. [Medline].

  20. Mack WJ, Preston-Martin S, Dal Maso L, et al. A pooled analysis of case-control studies of thyroid cancer: cigarettesmoking and consumption of alcohol, coffee, and tea. Cancer. 2003. 14(8):773-785. [Medline].

  21. Musholt TJ, Musholt PB, Petrich T, et al. Familial papillary thyroid carcinoma: genetics, criteria for diagnosis, clinical features, and surgical treatment. World J Surg. 2000 Nov. 24(11):1409-17. [Medline].

  22. Hall P, Adami HO. Thyroid Cancer. Adami H, Hunter D, Trichopoulos D, eds. Textbook of Cancer Epidemiology. 2nd ed. New York, NY: Oxford University Press; 2008.

  23. American Cancer Society. Cancer Facts & Figures 2015. American Cancer Society. Available at Accessed: October 8, 2015.

  24. Hay ID, Gonzalez-Losada T, Reinalda MS, Honetschlager JA, Richards ML, Thompson GB. Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg. 2010 Jun. 34(6):1192-202. [Medline].

  25. Yu XM, Wan Y, Sippel RS, Chen H. Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg. 2011 Oct. 254(4):653-60. [Medline].

  26. Miyauchi A, Kudo T, Miya A, et al. Prognostic impact of serum thyroglobulin doubling-time under thyrotropin suppression in patients with papillary thyroid carcinoma who underwent total thyroidectomy. Thyroid. 2011 Jul. 21(7):707-16. [Medline].

  27. Rivera M, Tuttle RM, Patel S, Shaha A, Shah JP, Ghossein RA. Encapsulated papillary thyroid carcinoma: a clinico-pathologic study of 106 cases with emphasis on its morphologic subtypes (histologic growth pattern). Thyroid. 2009 Feb. 19(2):119-27. [Medline].

  28. Suman P, Wang CH, Abadin SS, Moo-Young TA, Prinz RA, Winchester DJ. Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study. Surgery. 2015 Oct 1. [Medline].

  29. Cao J, Chen C, Chen C, Wang QL, Ge MH. Clinicopathological features and prognosis of familial papillary thyroid carcinoma - a large-scale, matched, case-control study. Clin Endocrinol (Oxf). 2015 Jul 20. [Medline].

  30. Bradly DP, Reddy V, Prinz RA, Gattuso P. Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery. 2009 Dec. 146(6):1099-104. [Medline].

  31. Kim KW, Park YJ, Kim EH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head Neck. 2011 May. 33(5):691-5. [Medline].

  32. Spencer CA. Clinical review: Clinical utility of thyroglobulin antibody (TgAb) measurements for patients with differentiated thyroid cancers (DTC). J Clin Endocrinol Metab. 2011 Dec. 96(12):3615-27. [Medline].

  33. Segev DL, Umbricht C, Zeiger MA. Molecular pathogenesis of thyroid cancer. Surg Oncol. 2003 Aug. 12(2):69-90. [Medline].

  34. Choi WH, Chung YA, Han EJ, Sohn HS, Lee SH. Clinical value of integrated [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in the preoperative assessment of papillary thyroid carcinoma: comparison with sonography. J Ultrasound Med. 2011 Sep. 30(9):1267-73. [Medline].

  35. Ng CM, Choi CH, Tiu SC. False-negatives in thyroid nodule aspiration cytology. Hong Kong Med J. 2007 Apr. 13(2):168-9. [Medline].

  36. Liu Z, Kakudo K, Bai Y, et al. Loss of cellular polarity/cohesiveness in the invasive front of papillary thyroid carcinoma, a novel predictor for lymph node metastasis; possible morphological indicator of epithelial mesenchymal transition. J Clin Pathol. 2011 Apr. 64(4):325-9. [Medline].

  37. Chao TC, Lin JD, Chen MF. Gasless video-assisted total thyroidectomy in the treatment of low risk intrathyroid papillary carcinoma. World J Surg. 2004 Sep. 28(9):876-9. [Medline].

  38. Ruggieri M, Straniero A, Pacini FM, et al. Video-assisted surgery of the thyroid diseases. Eur Rev Med Pharmacol Sci. 2003 Jul-Aug. 7(4):91-6. [Medline].

  39. Lee S, Ryu HR, Park JH, et al. Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg. 2011 Jun. 253(6):1060-6. [Medline].

  40. Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term Results of Observation vs Prophylactic Selective Level VI Neck Dissection for Papillary Thyroid Carcinoma at a Cancer Center. JAMA Otolaryngol Head Neck Surg. 2015 Jul. 141 (7):599-606. [Medline].

  41. Roh JL, Kim JM, Park CI. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol. 2011 Aug. 18(8):2245-50. [Medline].

  42. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. 2011 Dec. 150(6):1048-57. [Medline].

  43. Yim JH, Kim WB, Kim EY, et al. Adjuvant radioactive therapy after reoperation for locoregionally recurrent papillary thyroid cancer in patients who initially underwent total thyroidectomy and high-dose remnant ablation. J Clin Endocrinol Metab. 2011 Dec. 96(12):3695-700. [Medline].

  44. [Guideline] Sisson JC, Freitas J, McDougall IR, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine ¹³¹i: practice recommendations of the american thyroid association. Thyroid. 2011 Apr. 21(4):335-46. [Medline].

  45. Oluwasanjo A, Pathak R, Ukaigwe A, Alese O. Therapy-related acute myeloid leukemia following radioactive iodine treatment for thyroid cancer. Cancer Causes Control. 2015 Oct 9. [Medline].

  46. Heilo A, Sigstad E, Fagerlid KH, et al. Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab. 2011 Sep. 96(9):2750-5. [Medline].

  47. [Guideline] Salama JK, Golden DW, Yom SS, Garg MK, Lawson J, McDonald MW, et al. ACR Appropriateness Criteria® thyroid carcinoma. Oral Oncol. 2014 Jun. 50(6):577-86. [Medline].

  48. Perez CA, Santos ES, Arango BA, Raez LE, Cohen EE. Novel molecular targeted therapies for refractory thyroid cancer. Head Neck. 2012 May. 34(5):736-45. [Medline].

  49. Brassard M, Borget I, Edet-Sanson A, et al. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab. 2011 May. 96(5):1352-9. [Medline].

  50. Vadiveloo T, Donnan PT, Cochrane L, Leese GP. The Thyroid Epidemiology, Audit, and Research Study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011 May. 96(5):1344-51. [Medline].

  51. Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc. 2009. 84 (1):65-71. [Medline]. [Full Text].

  52. Rugge JB, Bougatsos C, Chou R. Screening for and Treatment of Thyroid Dysfunction: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. 2014 Oct. [Medline]. [Full Text].

  53. [Guideline] AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. American College of Endocrinology. Endocr Pract. 2001 May-Jun. 7(3):202-20. [Medline]. [Full Text].

  54. Al-Brahim N, Asa SL. Papillary thyroid carcinoma: an overview. Arch Pathol Lab Med. 2006 Jul. 130(7):1057-62. [Medline].

  55. Albores-Saavedra J, Wu J. The many faces and mimics of papillary thyroid carcinoma. Endocr Pathol. 2006. 17(1):1-18. [Medline].

  56. Baloch ZW, LiVolsi VA. Microcarcinoma of the thyroid. Adv Anat Pathol. 2006 Mar. 13(2):69-75. [Medline].

  57. Burman KD. Micropapillary thyroid cancer: should we aspirate all nodules regardless of size?. J Clin Endocrinol Metab. 2006 Jun. 91(6):2043-6. [Medline].

  58. Clark JR, Lai P, Hall F, et al. Variables predicting distant metastases in thyroid cancer. Laryngoscope. 2005 Apr. 115(4):661-7. [Medline].

  59. Das DK. Age of patients with papillary thyroid carcinoma: is it a key factor in the development of variants?. Gerontology. 2005 May-Jun. 51(3):149-54. [Medline].

  60. Donckier JE, Michel L, Delos M, et al. Interrelated overexpression of endothelial and inducible nitric oxide synthases, endothelin-1 and angiogenic factors in human papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2006 Jun. 64(6):703-10. [Medline].

  61. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. 2005 Jan. 12(1):81-9. [Medline].

  62. Hunt JL, Tometsko M, LiVolsi VA, et al. Molecular evidence of anaplastic transformation in coexisting well-differentiated and anaplastic carcinomas of the thyroid. Am J Surg Pathol. 2003 Dec. 27(12):1559-64. [Medline].

  63. Jukkola A, Bloigu R, Ebeling T, et al. Prognostic factors in differentiated thyroid carcinomas and their implications for current staging classifications. Endocr Relat Cancer. 2004 Sep. 11(3):571-9. [Medline]. [Full Text].

  64. Kim S, Wei JP, Braveman JM, et al. Predicting outcome and directing therapy for papillary thyroid carcinoma. Arch Surg. 2004 Apr. 139(4):390-4; discussion 393-4. [Medline].

  65. Lyshchik A, Drozd V, Demidchik Y, et al. Diagnosis of thyroid cancer in children: value of gray-scale and power doppler US. Radiology. 2005 May. 235(2):604-13. [Medline].

  66. Matsumoto F, Fujii H, Abe M, et al. A novel tumor marker, Niban, is expressed in subsets of thyroid tumors and Hashimoto's thyroiditis. Hum Pathol. 2006 Dec. 37(12):1592-600. [Medline].

  67. Mazzaferri EL, Robbins RJ, Spencer CA, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003 Apr. 88(4):1433-41. [Medline].

  68. Monchik JM, Donatini G, Iannuccilli J, et al. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg. 2006 Aug. 244(2):296-304. [Medline].

  69. Nikiforova MN, Nikiforov YE. Molecular genetics of thyroid cancer: implications for diagnosis, treatment and prognosis. Expert Rev Mol Diagn. 2008 Jan. 8(1):83-95. [Medline].

  70. Ohmori N, Miyakawa M, Ohmori K, et al. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis. Intern Med. 2007. 46(9):547-50. [Medline].

  71. Ramirez R, Hsu D, Patel A, et al. Over-expression of hepatocyte growth factor/scatter factor (HGF/SF) and the HGF/SF receptor (cMET) are associated with a high risk of metastasis and recurrence for children and young adults with papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2000 Nov. 53(5):635-44. [Medline].

  72. Riesco-Eizaguirre G, Gutierrez-Martinez P, Garca-Cabezas MA, et al. The oncogene BRAF V600E is associated with a high risk of recurrence and less differentiated papillary thyroid carcinoma due to the impairment of Na+/I- targeting to the membrane. Endocr Relat Cancer. 2006 Mar. 13(1):257-69. [Medline].

  73. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007 Apr. 245(4):604-10. [Medline].

  74. Rosario PW, Fagundes TA, Padrao EL, et al. Total thyroidectomy and lymph node dissection in patients with papillary thyroid carcinoma. Arch Surg. 2004 Dec. 139(12):1385. [Medline].

  75. Shaha AR. Prognostic factors in papillary thyroid carcinoma and implications of large nodal metastasis. Surgery. 2004 Feb. 135(2):237-9. [Medline].

  76. Shimura H, Haraguchi K, Hiejima Y, et al. Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study. Thyroid. 2005 Mar. 15(3):251-8. [Medline].

  77. Stephens LA, Powell NG, Grubb J, et al. Investigation of loss of heterozygosity and SNP frequencies in the RET gene in papillary thyroid carcinoma. Thyroid. 2005 Feb. 15(2):100-4. [Medline].

  78. Sugitani I, Fujimoto Y, Yamamoto N. Papillary thyroid carcinoma with distant metastases: survival predictors and the importance of local control. Surgery. 2008 Jan. 143(1):35-42. [Medline].

  79. Woodrum DT, Gauger PG. Role of 131I in the treatment of well differentiated thyroid cancer. J Surg Oncol. 2005 Mar 1. 89(3):114-21. [Medline].

  80. Zhu RS, Yu YL, Lu HK, et al. Clinical study of 312 cases with matastatic differentiated thyroid cancer treated with large doses of 131I. Chin Med J (Engl). 2005 Mar 5. 118(5):425-8. [Medline].

Standard open thyroidectomy.
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