How to treat papillary carcinoma of the thyroid

Three hundred and sixty-eight surgically-treated papillary thyroid carcinomas were analysed retrospectively to review the treatment of modalities and to make a study of indicators for optimum decision-making in the treatment. The surgical procedures used were: 220 ipsilateral lobectomies and isthmusectomies or subtotal thyroidectomies, 143 total or near-total thyroidectomies, and five debulking surgeries. Amongst the patients, 115 patients had various types of neck dissections for clinically positive neck nodes and 150 patients received adjuvant radioiodine therapy of which 112 patients were on an ablative basis, and 38 were on a therapeutic measure. All patients were placed on life-long TSH suppression therapy. Follow-ups were done from five to 12 years with a mean of 8.5 years. According to Cady and Rossi's AMES scoring system, the recurrence and death rate were significantly higher in patients in the high risk group than in those in the low risk group. Our experiences suggest that the choice of treatment for papillary thyroid carcinoma should be individualised based on the particular clinical situation encountered, a conservative approach for patients with low risks and an aggressive approach for those with high risks.