关键词: 甲状腺微小乳头状癌, 过度治疗, 治疗不足

Abstract:

Over-treatment and under-treatment of papillary thyroid microcarcinoma        ZHU Jing-qiang，LEI Jian-yong. Thyroid and Parathyroid Surgery Center，West China Hospital of Sichuan University，Chengdu 610041，China
Corresponding author：ZHU Jing-qiang，E-mail：zjq-wkys@163.com
Abstract    In recent years，the treatment for the papillary thyroid microcarcinom（PTMC）is controversial, which includes over-treatment and under-treatment in the clinical. The following protocols should be considered as “under-treatment”：ablation therapy is the first choice；against to the principle of “two at least”；for patients with proved contralateral lymph node metastasis only performed ipsilateral lobectomy and central lymph node dissection and lateral lymph node dissection；for patients with node in the contralateral lobe only performed ipsilateral lobectomy；cases should accept surgery therapy but failed；inappropriate TSH suppression therapy without evaluation and follow-up after surgery. The following protocols should be considered as “over-treatment”：PTMC with diameter less than 5 mm，without lymph node metastasis and no risk factors of capsular invasion，but accepting total thyroidectomy or unilateral/bilateral central lymph node dissection；cases have accepted lobectomy and the postoperative histological examination indicated the “accidental carcinoma”，but been advised to accept the central lymph node dissection without evidence of lymph node metastasis；PTMC patients with diameter less than 5 mm accepted surgery in the early or late pregnancy period；cases accepted over TSH suppression therapy and the follow-up less than 3 months. So the surgeon should have a correct understanding of PTMC with correct assessment，safety consideration of surgery，patients’ will and medical resources，and then make the reasonable diagnosis and treatment protocols.

Key words: papillary thyroid microcarcinoma, over-treatment, under-treatment