What are the NCCN treatment guidelines for papillary thyroid carcinoma?

Updated: May 09, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

NCCN guidelines recommend total thyroidectomy for patients who meet any of the following criteria [33] :

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

The NCCN considers either total thyroidectomy or lobectomy to be acceptable for patients who meet all of the following criteria [33] :

  • No prior radiation
  • No distant metastases
  • No cervical lymph node metastases
  • No extrathyroidal extension
  • Tumor <4 cm in diameter

If a lobectomy is performed, completion of the thyroidectomy is recommended for any of the following [7] :

  • Tumor >4 cm in diameter
  • Positive margins
  • Extrathyroidal extension
  • Macroscopic multifocal disease
  • Macroscopic nodal metastases
  • Confirmed contralateral disease
  • Vascular invasion

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