Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm?

To evaluate tumor recurrence after total thyroidectomy in patients with single papillary carcinoma with size <= 2 cm and restricted to the thyroid, we studied 136 consecutive patients divided into two groups according to post-operative management: no ablative therapy (n = 42) (group 1) and ablation with 1.1 GBq (n = 36) or 3.7 GBq I-131 (n = 58) (group 2). None of the patients were submitted to central-compartment (VI level) neck dissection. Thyroid-stimulating hormone (TSH) levels were > 0.5 mIU/L in >= 50% of the measurements in all patients. Complete remission (stimulated thyroglobulin (Tg) <= 1 ng/mL, undetectable antithyroglobulin antibodies (TgAb), and negative imaging methods) was observed in 83% of the patients in group 1 and in 89% in group 2 (p = 0.4), and none of the patients presented apparent disease during follow-up (mean: 6 years). Posttherapy whole-body scanning was available in 74 patients, and none of them showed ectopic uptake. TgAb were still present in 7.1% of the patients in group 1 and in 8.5% in group 2 (p > 0.05). Six patients who still had stimulated Tg > 1 ng/mL (< 5 ng/mL) showed a > 50% decrease in comparison with Tg measured 12-24 months earlier. In conclusion, we suggest a more conservative approach with respect to central-compartment neck dissection, postoperative I-131, and suppressive therapy in patients with small tumors restricted to the thyroid.