Controversies in primary treatment of low-risk papillary thyroid cancer

Lancet. 2013 Mar 23;381(9871):1046-57. doi: 10.1016/S0140-6736(12)62205-3. Epub 2013 Mar 22.


In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Carcinoma / diagnosis
  • Carcinoma / therapy*
  • Carcinoma, Papillary
  • Contraindications
  • Fathers
  • Female
  • Humans
  • Iodine Radioisotopes / therapeutic use
  • Lymph Node Excision / methods
  • Lymphatic Metastasis
  • Male
  • Pregnancy
  • Pregnancy Complications / chemically induced
  • Pregnancy Complications / prevention & control
  • Radiation Protection
  • Radiopharmaceuticals / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Thyroid Cancer, Papillary
  • Thyroid Neoplasms / diagnosis
  • Thyroid Neoplasms / therapy*
  • Thyroidectomy / methods
  • Thyrotropin / antagonists & inhibitors


  • Iodine Radioisotopes
  • Radiopharmaceuticals
  • Thyrotropin