Papillary carcinoma is the most common among malignant tumors of the thyroid (60-70% of all thyroid carcinomas). Women are affected two to three times more often than men. It is more common in young people, but in the elderly has increased malignancy.
It is more common in patients with a history of exposure to radiation and spreads through the lymphatic. You may find lateral aberrant thyroid remnants that are actually occult metastases with a benign histological appearance. These well-differentiated carcinomas may be TSH-dependent and may develop in the context of goiters secondary to Hashimoto’s thyroiditis. Many papillary carcinomas contain follicular elements, but this does not change the basic biology of the tumor.
The treatment of small tumors (<1.5cm) encapsulated and localized in one lobe is usually in the lobectomy, although some experts recommend a more extensive surgical treatment. Thyroid hormones in the TSH suppressive doses are administered to minimize the possibility of a new growth or induce regression of any residual microscopic papillary carcinoma, surgical treatment is almost always decisive.
The large tumors (> 1.5 cm) or widespread often require total or subtotal thyroidectomy with postoperative radioiodine scintigraphy and subsequent ablation of residual thyroid tissue with sufficiently high doses of 131 I administered when the patient is hypothyroid . Alternatively, it can be administered recombinant TSH (not yet available) for 2 days before 131 I diagnostic scan performed to detect residual thyroid tissue or tumor, thereby avoiding the need to become hypothyroid patients before scintigraphy itself. May be necessary to repeat treatment every 6-12 months to achieve complete ablation of residual thyroid tissue. After treatment are TSH-suppressive doses of L-thyroxine and determination of serum thyroglobulin is useful for detecting the recurrence or persistence of the disease.