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Strategies for Managing Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements From JAES

By: Hope Craig, MSPH
Posted: Tuesday, April 13, 2021

Led by the Japan Association of Endocrine Surgery (JAES), a task force on the management of papillary thyroid microcarcinoma (PTMC) recently released consensus statements regarding indications and strategies for active surveillance of adults with low-risk disease. Using results from prospective clinical trials spanning over 3 decades, the statements present evidence-based recommendations for active surveillance of low-risk PTMC as well as knowledge gaps for future research.

“The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing active surveillance as long as circumstances permit,” according to Iwao Sugitani, MD, PhD, of the Nippon Medical School Graduate School of Medicine, Japan, and colleagues.

In the statements published in the journal Thyroid, the authors distinguish between cases that warrant immediate surgery versus low-risk cases amenable to active surveillance. Practical strategies for low-risk cases include diagnosis, decision-making, follow-up, and monitoring related to the implementation of active surveillance. In addition, the authors describe future tasks to optimize the management of PTMC, including molecular markers and patient-reported outcomes.

The authors advocate for multidisciplinary teams to evaluate an individual patient’s diagnosis and disease progression and encourage joint decision-making with the patient. Factors that may affect decision-making about active surveillance include age, multiplicity of lesions, family history, desire to bear children and pregnancy, calcification, vascularity, and coexistence of Graves’ disease and benign nodules.

The evidence-based recommendations highlight active surveillance of low-risk PTMC as a safe, low-cost management strategy to support favorable patient outcomes and quality of life.

Disclosure: The authors reported no conflicts of interest.

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