Microcarcinoma papilar de tiroides. ¿Es necesario el tratamiento con 131I tras la cirugía? Argumentos a favor

Papillary thyroid microcarcinoma (PTM) is a malignant lesion with a diameter of 10 mm or less. In our experience, it accounts for 18.5% of all cases of papillary carcinoma and its incidence has been increasing in recent years. In a high percentage of patients, each of the foci in multicentric PTM has an independent clonal origin. Although it has an excellent prognosis, with mortality rates 30 years after surgical treatment below 3%, PTM may give rise to significant morbidity in terms of loco-regional recurrence and/or distant metastases. Clinically, it may present as an incidental lesion, discovered unexpectedly after surgery for benign thyroid disease, or non-incidentally, detected before surgery due to lymph node metastases, distant metastases and/or fineneedle aspiration biopsy of the thyroid, whether guided by ultrasonography or not. Given the absence of prospective, well designed clinical trials, treatment of this entity is controversial. The various guidelines do not agree on therapeutic procedures or follow-up methods. For the past 35 years, we have been performing a relatively uniform therapeutic protocol of total or near total thyroidectomy followed by 131I ablation therapy in most of our patients. So far mortality and morbidity have been acceptable. This approach also facilitates the follow-up of an entity for which no specific markers of future recurrence are available.