Papillary thyroid cancer.

Papillary thyroid cancer is the most common neoplasm of the thyroid gland. Surgical resection is the cornerstone of therapy. There is controversy regarding the extent of resection, ranging from thyroid lobectomy plus isthmusectomy to total thyroidectomy, but in experienced hands total thyroidectomy has many significant advantages over a lesser operation. Nonoperative therapy has no role as primary therapy for papillary thyroid cancer, but can be used in conjunction with surgery to improve outcome. Radioiodine in patients who have received total thyroidectomy can be used to identify residual occult tumor, recurrence, and metastasis, and can also be used to ablate the neoplasm, resulting in a substantial cure rate. Thyroid hormone is needed as replacement after total thyroidectomy, but can also be given as thyroid-stimulating hormone suppression, which may have an adjunctive benefit after resection.