| Abstract: |
The traditional approach to the management of thyroid carcinoma has been total thyroidectomy followed by radioactive iodine ablation and levothyroxine suppressive therapy. However, there is cumulative evidence to suggest that the prognosis of unresected, biopsy-proven papillary microcarcinomas is excellent and an active surveillance approach can be considered as an alternative to immediate surgery. Tumor characteristics including size, location, capsular invasion, and proximity to the recurrent laryngeal nerve; patient characteristics including comorbidities, willingness to follow-up, age, and pregnancy potential; and medical team characteristics such as sonographic equipment, medical expertise in the follow-up of patients with thyroid cancer, and agreement among different patient providers define optimal, adequate, and inappropriate patients to be followed with an active surveillance approach. Molecular markers are being optimized as an additional risk-stratifying variable. The parameters that favor discontinuation of an active surveillance approach and the indication for surgery including tumor growth, spread to cervical lymph nodes, extension outside the thyroid capsule, and markers of clinical aggressiveness need to be clearly defined upfront. © Springer Nature Switzerland AG 2021. |
