Microcarcinomas are very small cancer growths measuring less than 1 cm in diameter. Nearly 30% of papillary thyroid cancers fit into this category. Provided that there is no further cancer in the thyroid or elsewhere, your doctor may feel that radioactive iodine (RAI) therapy is not required.
If your family doctor thinks you may have thyroid cancer, you will be referred to a nuclear medicine doctor or an endocrinologist, who will conduct various tests in order to confirm your diagnosis. You will then be referred to a surgeon experienced in thyroid surgery.
It is worth the effort of travelling to a specialist thyroid surgery centre if this choice is available to you. The risks associated with thyroid surgery are highly dependent on the experience and skill of the surgeon. The number of thyroid operations performed each year in a department or hospital is a good indicator of its expertise in thyroid surgery. This kind of information and other figures can be found in the hospital's quality reports - these are often mandatory and usually available on the internet.
Immediate administration of thyroid hormone replacement for medical reasons is possible for most patients, and timely coordination between surgeon, nuclear medicine doctor and endocrinologist is important to ensure optimal post-surgical follow-up.
Things to consider:
- The time interval between surgery and deciding whether or not radioactive iodine treatment should be administered, should be kept as short as possible in order to reduce the total treatment duration.
- A decision needs to be taken on when to initiate thyroid hormone replacement therapy. Several clinics offer radioactive iodine ablation under recombinant human TSH (rhTSH). This allows initiation of thyroid hormone replacement therapy immediately after surgery, which helps to avoid the sometimes serious side effects of hypothyroidism.