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41

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

Guide 10. Observe or thyroidectomy for papillary

Primary treatment Consider after treatment Next steps of care

Lobectomy with

removal of the

isthmus

ª

• Tumor larger than 4 cm

• Positive margins

• Vascular (blood vessel)

invasion

• Spread of cancer in areas

such as the lymph nodes,

other thyroid lobe, and

beyond the thyroid

• Poorly differentiated (may

spread quickly)

ª

• Complete thyroidectomy

• Tumor 1 to 4 cm

or

• Cancer has spread to the

lymph vessels

ª

• Complete thyroidectomy

ª

• Observe

ª

• Consider

levothyroxine

therapy to

keep TSH low

or normal

ª

• Tumor smaller than 1 cm

• Negative margins

• No cancer in the other

thyroid lobe

• No concern for cancer in

lymph nodes

ª

• Observe

ª

• Consider

levothyroxine

therapy to

keep TSH low

or normal

Guide 10

describes what can happen after you

have a lobectomy with removal of the isthmus for

papillary thyroid cancer. Your doctor considers the

tumor size and the margin status (if cancer remains

in the normal-looking tissue around the tumor). He or

she also wants to know if and where the cancer has

spread in the neck area. This includes checking your

lymph nodes.

If the tumor is larger than 4 cm and other factors

are present like the spread of cancer into blood

vessels or lymph nodes, you may have a complete

thyroidectomy. You may also have a complete

thyroidectomy if the tumor is 1 to 4 cm or in the lymph

vessels (lymphatic invasion). If the tumor is smaller

than 1 cm and there is no further cancer or concern

for cancer, your doctor may watch you closely

(observe) for any disease growth. You may also take

levothyroxine to keep the TSH low or normal.

5

Treatment guide

Papillary thyroid cancer