The Implications of Micro-Papillary Thyroid Carcinoma in Surgical Treatment of Multi-nodular Goiter

Background: papillary thyroid micro-carcinoma (PTMC) is defined as papillary thyroid carcinoma less than 10mm in diameter, it is common pathology and form one third of PTC, its management is debatable due to its aggressive behavior in some cases. its diagnosis are done incidentally in most of cases but recent ultrasound with FNCA increase the incidence of diagnosis. Patients and methods: The Study is conducted on 147 cases of papillary thyroid carcinoma (PTC) that operated upon between 2018-2022 for goiter randomly. The type of surgery is either lobectomy, total thyroidectomy or partial thyroidectomy. The pathologist decreases the thyroid lesion to less than few mm in diameter instead of more than 10 mm that done previously. the cases are divided into 3 group: group A include micro-carcinoma; group B include malignant nodule more than 1 cm in multi-nodular goiter (MNG) and group C that include single papillary nodule. Result: of 149 cases with PTC, 47 cases are PTMC (group A), 27 cases are in group B that include PTC more than one centimeter in diameter and group C that present with solitary malignant nodules that include 75 cases. Of 47 cases with PTMC, 27 cases contain malignant foci between 1-3 mm while in 11 cases, the size between 4-5 mm and 9 cases with diameter between 6 to 9 mm. Thirty–nine of PTMC cases are seen in MNG, 7 cases in Hashomoto s thyroiditis and one case in graves’ disease. Ten of 16 cases of colloid MNG are between, the size of malignant nodule are in range of 1-1.5 cm. seven of 11 cases of PTC in Hashomoto s are multifocal. Conclusion: PTMC is common pathology, mainly seen in MNG, and in most of the cases, they are small in size 3mm or less in diameter and difficult to recognize by ultrasound so adoption of total lobectomy or total thyroidectomy instead of partial thyroidectomy ensure complete excision of this pathology which may have unexpected behavior in some cases. PTC (more than 1 cm) on background of MNG, mainly are of small size and present in non-dominant nodule.