���ⲡ�����ͼ�״��΢С������

??Management for rare pathological subtype case of thyroid microcarcinoma LI Xiao-xi. Department of Vascular-Thyroid-Breast Surgery??the First Affiliated Hospital??Sun Yat-sen University??Guangzhou 510080??China
Abstract Papillary thyroid microcarcinoma is the most common type of thyroid microcarcinoma. Other uncommon variants have been described including follicular variant papillary thyroid microcarcinoma??follicular thyroid microcarcinoma??Hurthle cell microcarcinomas??tall cell variants??diffuse sclerosing variant and so on. Total/near total thyroidectomy with neck dissection may be the optimal surgical procedures for high-risk thyroid microcarcinoma patients who have gross lymph node metastasis??extrathyroid involvement and distant metastasis at presentation. Loboisthmusectomy may be a sufficient treatment of choice for patients with low-risk thyroid microcarcinoma when thyroid cancer less than 1 cm??unifocal??intrathyroidal??without extrathyroid invasion and lymph node metastasis.     

特殊病理类型甲状腺微小癌诊治

在甲状腺微小癌中乳头状癌最多见,其他少见的特殊病理类型有滤泡变异型、滤泡型、嗜酸细胞型、高细胞亚型、弥漫硬化压型等。对有明显的颈部淋巴结转移、甲状腺外浸润和远处转移的高危病人,理想的手术方式是甲状腺全或近全切除术+淋巴结清扫。甲状腺癌肿瘤直径<1 cm、单发病灶局限于腺叶内、无甲状腺外浸润、无颈部淋巴结转移、复发危险度低的病人,可以行甲状腺腺叶+峡部切除术。     

What is the biology and optimal treatment for papillary microcarcinoma of the thyroid?

BACKGROUND: Papillary microcarcinomas of the thyroid, defined as tumors measuring < or =10 mm, are believed to be a less aggressive subset of papillary cancers that behave more like benign lesions and are often more conservatively treated. However, some groups have reported a high incidence of metastases from papillary microcarcinomas and favor aggressive surgical resection followed by radioiodine therapy. Therefore, to characterize the biology and optimal treatment for papillary microcarcinomas, we reviewed our experience. METHODS: From May 1994 to October 2004, 184 patients underwent thyroid surgery at the University of Wisconsin and had papillary thyroid cancer present in the resected gland. Of these patients, 10 were excluded because there was no record of tumor size. Of the remaining 174 patients, 74 (42%) had papillary microcarcinomas. Data from these patients were retrospectively analyzed. RESULTS: The mean age of these patients was 42 +/- 1.48 year and 57 (77%) were female. The mean tumor size was 5.7 +/- 0.38 mm. Of the 74 patients, 12 (16%) had lymph node metastases. The majority of patients (65%) underwent a total thyroidectomy and 61% had radioiodine ablation therapy after surgery. With follow-up up to 134 months, the recurrence rate was 8% and only two patients currently have active disease. No patients with papillary microcarcinoma have died during this period. CONCLUSION: Papillary microcarcinomas of the thyroid are quite common, comprising almost half of all papillary cancers. Despite a significant rate of metastatic disease, the prognosis for patients with microcarcinomas has been excellent with 100% survival and a low recurrence rate. These outcomes may be the result of the aggressive surgical therapy used at our institution. Thus, papillary microcarcinomas appear to have a similar biology to other low risk papillary thyroid cancers and, in our opinion, may warrant similar treatment.     

Incidental thyroid microcarcinoma in benign thyroid disease. Incidence in a total of 100 consecutive thyroidectomies

Over the past few years, incidental thyroid microcarcinoma has become a frequent disease and its incidence in some reports is considerable. Discovering new cases depends on the extended indications for total thyroidectomy for benign disease, on progress in the field of diagnostic instruments (ultrasound, scintigram, fine needle biopsy for cytology, CT scan, MRI), and on the pathology examination of very thin slices of specimens. In spite of the high incidence reported in some autopsy series, suggesting that this tumour may have a good prognosis, some Authors report an overall incidence of up to 11% of local recurrence, metastasis or mortality. For all these reasons the surgical treatment of incidental thyroid microcarcinoma is still controversial. The aim of this study was to estimate the incidence and examine the clinical-pathological findings of incidental thyroid microcarcinoma in a series of 100 consecutive thyroidectomies and to evaluate whether complete removal of the gland should be adopted in all cases. In the present series the incidence of incidental thyroid microcarcinoma was 21.6% (19/88). Total thyroidectomy was considered the treatment of choice for diffuse benign disease and appeared to be necessary for both the diagnosis and treatment of incidental thyroid microcarcinoma.     

Occult Micro Medullary Thyroid Carcinoma: Therapeutic Strategy and Follow-up

Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers). Altogether, 18 patients had unifocal micro-MTCs with a median diameter of 3.6 mm. One patient had a bilateral MTC (3 and 5 mm, respectively). Surgical procedures consisted of 9 total thyroidectomies and 10 lobectomies or subtotal thyroidectomies. Of these 10 patients, 4 underwent reoperation (totalization). One was operated on 48 months after a positive pentagastrin test: There was no thyroid residual tumor but three lymph node micrometastases. Among the six patients in whom thyroid tissue was left, a 91-year-old woman died of unrelated cause and the five others remain disease-free without biologic abnormalities at follow-ups of 18 to 70 months. Considering the aggressiveness of MTCs, total thyroidectomy with central compartment dissection is theoretically indicated. However, among the nine total thyroidectomies and four secondary totalizations associated with at least central compartment dissection, no other thyroid lesion was observed and only one case of lymph node microinvasion was found. Because of the morbidity associated with reoperation and neck dissection, we propose that it is indicated only for microcarcinomas > 5 mm in diameter, in cases of an abnormal response to pentagastrin, or when it is difficult to ensure prolonged follow-up of the patient.     

Thyroid microcarcinoma and multinodular struma. Personal experience and considerations regarding surgical therapy

Thyroid microcarcinoma is a malignant papillary tumour of the thyroid gland measuring < or = 1.0 cm in diameter. Prognosis and treatment are controversial. We report on a personal series of 28 cases of thyroid microcarcinoma observed over the period from 2000 to 2004. From 2000 to 2004, 199 consecutive total thyroidectomies were performed in patients with multinodular struma. The histological diagnosis was made by a pathologist according to the recommendations of the World Health Organization by means of sections of the thyroid gland of no more than 2 mm. At routine histological examination, 28 cases (14.07%) of "incidental" thyroid microcarcinoma were found. The mean tumour size was 4.10 mm (range: 0.12 to 10 mm). The tumours were multifocal in 2 patients, and none presented lymph node metastases. Thyoid microcarcinoma is a malignant tumour associated with a good prognosis. Multifocality should be the main factor considered in selecting the type of thyroid surgery. A total thyroidectomy may be regarded as sufficient treatment.     

甲状腺乳头状微小癌与非微小癌的超声特征

目的分析甲状腺乳头状微小癌与非微小癌的声像图特征。方法回顾性分析242例经手术病理证实的甲状腺乳头状癌患者的超声声像图特征,将其分为直径≤1cm微小癌和直径〉1cm非微小癌,对比两者在形态、纵横比、边界、回声、声晕、钙化、囊变、血流、颈部淋巴结转移及合并甲状腺疾病等方面的差异。结果242例共287个癌灶,其中39例为多灶性（39／242,16．12％）;微小癌154个,非微小癌133个。超声检出274个病灶,漏诊微小癌13个,误诊为结节性甲状腺肿或腺瘤等良性病灶42个。甲状腺乳头状微小癌与非微小癌的边界、纵横比、囊变、血流及颈部淋巴结转移率差异有统计学意义（P均〈0．05）,而在形态、钙化、声晕及合并甲状腺疾病上差异无统计学意义（P均〉0．05）。结论超声在甲状腺乳头状癌的诊断中具有重要价值;甲状腺乳头状微小癌与非微小癌的超声表现具有差异。     

ȷ���������״��΢С��ͷ״�������������ܰͽ�ת��������о�

??A study on the correlation between the age of diagnosis and the neck central lymph node metastases in papillary thyroid microcarcinomas LI Xiao-jing??YANG Le??MA Bin-lin. Department of Breast, Head and Neck Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi 830011,China
Corresponding author: MA Bin-lin,E-mail:mbldoctor@126.com
Abstract Objective To determine the pathologic characteristics and predictive factors that increased the neck cental lymph node metastasis??CLNM??in papillary thyroid microcarcinoma??PTMC??. Especially??to determine the correlations between age and the neck central lymph node metastases at different age cutoffs ??and the real relation between age and the central lymph node metastases in papillary thyroid microcarcinomas. Methods The clinical and pathologic data collected from 1988 patients who were firstly diagnosed with PTMC at the Affiliated Tumor Hospital of Xinjiang Medical University between January 2010 and March 2016 were analyzed retrospectively. Chi-square test ??the curve of receiver operating characteristic??ROC?? and multivariate Logistic regression analysis were used to identify the risk factors of the neck central lymph node metastasis. Age at diagnosis was cut from 25 to 70 years at 5-years intervals and was cut from 30 to 60 years at 1-years intervals again, in order to determine the correlations between age and the central lymph node metastases in papillary thyroid microcarcinomas. Results Of all 1988 patients??34.9% had the neck central lymph node metastasis??and the rate of the neck central lymph node metastasis declined with the age increasing. However??in papillary thyroid microcarcinomas??except for age cutoff of 70 years??age was independently correlated with the neck cental lymph node metastasis at different age cutoffs which was from 25 to 70 years at 5-years intervals or from 30 to 60 years at 1-years intervals. Multivariate logistic regression analysis indicated that male?? the number of focality ≥3?? tumor diameter ??5 mm?? unifocal tumor location in the lower third of the thyroid lobe ??capsular invasion were independently correlated with the neck central lymph node metastasis??P<0.05??. Conclusion Age at diagnosis??not being a cutoff?? only reflects variation tendency. And regarding age as continuous variable is more superiority in the study between age and the central lymph node metastases in papillary thyroid microcarcinom. Then?? more aggressive treatment or more frequent follow-up could be considered for patients with unfavorable features ??male?? the number of focality ≥3?? tumor diameter ??5 mm??capsular invasion??unifocal tumor location in the lower third of the thyroid lobe???? as the patients may be at an increased risk for the neck cental lymph node metastasis.     

��״��΢С�����ν��㼰����

??Focal points and controversies of the diagnosis and treatment for thyroid microcarcinoma WU Yi. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Thyroid Tumor Diagnosis and Treatment Research Center, Fudan University??Shanghai 200032??China
Abstract Thyroid microcarcinoma (TMC) is defined as a thyroid cancer measuring ≤1 cm in greatest diameter. Since more and more thyroid microcarcinomas have been detected frequently, it needs to explore the standard diagnosis and treatment of TMC. For the TMCs diagnosed definitively, standardized treatment of thyroid carcinoma should be adopted. Strict indications of non-operative-management should be grasped for TMC. Careful analysis of the history, strict operation indications and non-neoplasm touch technology are required when treating TMC by endoscopy. Furthermore, domestic surgeons should also learn the advanced experience from foreign colleagues in order to enhance the ability of diagnosing and treating TMC in China.     

甲状腺全切除术治疗甲状腺微小癌128例临床分析

目的：分析甲状腺微小癌的临床、病理特点,探讨甲状腺全切除术在治疗甲状腺微小癌中的意义。 方法：回顾性分析2009年10月—2012年12月经手术和病理证实的128例甲状腺微小癌患者的临床资料。患者均行甲状腺全切除术,部分行辅助131I治疗。 结果：128例患者中,单发微小癌87例（67.97%）,多发微小癌41例（32.03%）;单发微小癌肿瘤直径均在0.3 cm以上,术前经超声检查可发现病灶;多发微小癌术前超声可明确所有病灶者25例（60.98%）,另16例（39.02%）多发微小癌中除较大的病灶（>0.3 cm）在术前超声检查中明确外,其余病灶均是在术中冷冻切片中发现或术后石蜡切片中发现;多发病灶局限于单侧甲状腺腺体者 22例（53.66%）,分散于双侧腺体者19例（43.34%）。术后随访率100%,1例出现颈部淋巴结转移。 结论：掌握甲状腺微小癌的临床、病理特点,仔细检查,可避免漏诊;甲状腺全切除术对治疗甲状腺微小癌有重要意义。     

Simultaneous occurrence of papillary intrafollicular and microcarcinomas with bilateral medullary microcarcinoma of the thyroid in a patient with multiple endocrine neoplasia type 2A: report of a case

We report the case of a simultaneous occurrence of papillary intrafollicular and microcarcinomas with bilateral medullary microcarcinoma of the thyroid in a patient with multiple endocrine neoplasia type 2A. The concurrent presence of two thyroid carcinomas is rare. The simultaneous occurrence of two different tumors in the same thyroid each being multifocal and smaller than 1 cm in diameter has not been previously reported in the literature. Furthermore, we define the first case of intrafollicular papillary thyroid carcinoma (carcinoma in situ). Received: June 11, 2001 / Accepted: January 8, 2002     

Surgical treatment of Hashimoto's thyroiditis. Personal experience

BACKGROUND: To report personal experience in the surgical treatment of Hashimoto's thyroiditis. METHODS. Eight patients (7 females, 1 male, mean age 48 years old) referred to our Institution with diagnosis of Hashimoto's thyroiditis have been studied. All patients were evaluated by determination of serum thyroid hormones and of anti-thyreoglobulin and anti-microsomal antibodies; ultrasound and scintigraphic scans of the gland were performed in all cases and a cytological examination of fine needle aspiration (FNAC) of the nodules was evaluated. Diagnosis of Hashimoto's thyroiditis was suspected on the basis of clinical and laboratory data and was confirmed by cytology and histology on surgical specimens. Preoperative FNAC showed a Hashimoto's thyroiditis with thyroid differentiated carcinoma in 3 cases (37.5%), Hashimoto's thyroiditis in 1 case and chronic thyroiditis in 4 cases (50%). Seven patients underwent surgery, while 1 patient received a medical treatment; we performed 6 total thyroidectomies and 1 hemithyroidectomy. Histology on surgical specimens confirmed the diagnosis of Hashimoto's thyroiditis in all cases; in 3 patients an associated papillary thyroid carcinoma was found. RESULTS: Postoperative mortality was absent; no major postoperative complications (laryngeal nerve paralysis or permanent hypocalcemia) were recorded. Only 2 mild transient hypocalcemias have been observed. CONCLUSIONS: Total thyroidectomy is the technique of choice in surgical treatment of Hashimoto's thyroiditis, a self-immune pathology which involves the whole gland and has a high correlation with differentiated thyroid carcinoma (37.5%). Total thyroidectomy warrants a radical and definitive control of the disease, without risk of relapse, with a low incidence of major complications, in experienced hands, and anyway lower than the morbility due to reinterventions.     

Thyroid microcarcinoma: our experience

Differentiated thyroid cancer had an excellent prognosis; the diagnosis of sub-centimetric differentiated cancer (microcarcinoma) is more and more frequently. Clinical evolution of microcarcinoma could be various: microcarcinoma can represent an autoptic finding or can evolve with locoregional lymph node involvement or metastasis. Various clinical and genetic factors have been considered to predict the aggressiveness of this neoplasm. From 2001 to 2004, 74 patients with diagnosis of thyroid microcarcinoma underwent surgical treatment. By a retrospective survey we evaluated risk factors and the choice of surgical treatment. The aggressiveness appear to be related mainly to multifocality and size. Our therapeutic strategy is to perform total thyroidectomy for benign pathologies, total thyroidectomy with lymphadenectomy in cases with preoperative diagnosis of microcarcinoma.     

Occult distant metastases of well-differentiated thyroid carcinoma

Background. The tendency of well-differentiated thyroid carcinoma to remain localized and its slow progression have supported the belief that this disease behaves as a low-grade malignancy. Consequently, a conservative approach in the management of the well-differentiated thyroid carcinoma has existed during the years. Occult distant metastases of thyroid cancer is an occasional finding considered of ominous significance. Methods. In a retrospective study, we reviewed the records of 187 adult patients with well-differentiated thyroid carcinoma treated by total thyroidectomy. These cases were found among 1,240 thyroidectomies performed in our department between 1982 and 1993. Occult distant skeletal and lung metastases disclosed by total body¹³¹I scans, after total thyroidectomy, were present at the time of initial treatment in 11 patients (11/187). This group included 9 women and 2 men ranging in age from 36 to 70 years, with a mean age of 47 years. Seven patients had papillary carcinoma, whereas follicular malignancy was found in four. Review of the surgical specimens showed total involvement of the gland in 5 cases, with extracapsular tumoral spread in 3 patients. Multicentric disease was present in 6 specimens. Patient follow-up revealed a mortality rate of 64% (7/11) during the first 3 postoperative years. Conclusions. Analysis of this population confirms that well-differentiated thyroid carcinoma with distant metastases is an aggressive disease with lethal consequence. Early detection and therapy of occult distant metastases present at the time of initial treatment is possible only after total thyroid ablation, because otherwise the radioactive iodine is trapped by the gland's remnants. © 1994 John Wiley & Sons, Inc.     

甲状腺功能亢进合并甲状腺微小癌的外科诊治分析

目的　探讨甲状腺机能亢进 (甲亢 )合并甲状腺微小癌 (thyroidmicrocarcinoma ,TMC)的外科诊断和治疗。方法　分析 1990年 3月～ 2 0 0 3年 8月期间收治的 2 687例甲亢患者中合并甲状腺微小癌的 18例患者的外科诊断和治疗及其预后。结果　本组甲亢与甲状腺微小癌的并存率为 0 .67% ( 18/2 687)。术前确诊 4例 ,术中明确诊断 10例 ,术后病理确诊 4例。其中 2例患者行第二次手术 ,1例补切患侧残余腺体 ,另 1例除补切患侧残余腺体外并加功能性淋巴结清扫。术后随访 10个月～ 14年 ,3例患者再手术后无复发。结论　甲状腺机能亢进合并甲状腺微小癌术前确诊困难 ,术前应详细触诊 ,甲亢患者合并甲状腺结节者应常规作术中快速冰冻切片检查 ,甲状腺叶全切或次全切对治疗甲亢合并甲状腺微小癌具有良好的临床效果     

cNO期甲状腺微小乳头状癌中央区淋巴结转移的危险因素及预防性清扫的临床分析

目的 探讨临床颈淋巴结阴性(cN0期)甲状腺微小乳头状癌中央区淋巴结转移的临床特点及预防性清扫的意义及可行性,为临床治疗提供参考.方法 回顾性分析2011年7月-2015年12月在连云港市东方医院普外科接受手术的277例cN0期甲状腺微小乳头状癌患者的临床资料,评估预防性中央区淋巴结清扫的必要性,采用x2检验及Logistic回归分析中央区淋巴结转移与患者的性别、年龄、肿瘤数目、肿瘤大小、包膜浸润、单双侧肿瘤的关系.277例患者全部行原发灶根治性切除加患侧中央区淋巴结清扫术,清扫标本送检常规病理检查.结果 甲状腺微小乳头状癌中央区淋巴结转移阳性率为36.8％(102/277),在男性患者(P=0.023)、年龄＜45岁(P＜0.001)和肿瘤直径＞0.5 cm(P =0.019)中阳性率高;通过多变量分析可以表明男性患者(OR =2.63,P＜0.001)、年龄＜45岁(OR =2.25,P=0.016)、肿瘤直径＞0.5 cm(OR =2.13,P=0.009)均能独立作为CLN转移的危险因素.15例(5.4％)出现暂时性喉返神经麻痹,43例(15.5％)出现暂时性甲状旁腺功能低下,无永久性喉返神经麻痹和甲状旁腺功能低下并发症患者.结论 预防性中央区淋巴结的清扫有助于准确进行肿瘤的分期分级以及危险度的评估,对患者术后治疗随访方案的选择有重要意义,对于男性、年龄＜45岁、肿瘤直径＞0.5 cm、有包膜浸润的患者应常规行中央区淋巴结清扫.     

A regional study of thyroidectomy: surgical pathology suggests scope to improve quality and reduce cost.

This study of thyroid histopathological data from hospitals in the South West Thames region was undertaken to assess current practice and the scope for improvement. Over a 6 month period, 186 thyroid operations were performed on 179 patients at eight hospitals serving almost 1.7 million people. The frequency of thyroidectomy in different hospitals varied from 13 to 35 per 100,000 per year and 6.4% of the operations were second thyroidectomies. Benign multinodular goitre was the most common histological finding (34%). A benign solitary nodule was found in 36% and malignancy in 8.4% of the specimens. Correlation of histological analysis and type of operation suggested that a variety of operations were performed for the same pathological condition and that some operations were diagnostic procedures only. Overall, 63 of the 186 operations (34%) might have been avoided by a firm preoperative diagnosis. Only 67 thyroid fine needle aspiration biopsies (FNAC) were performed at the eight hospitals during the study period. Only 15 (8%) of the patients who underwent thyroid operation had been investigated by FNAC. Reduction in thyroid surgery through more widespread use of FNAC could result in savings of 100,000 pounds per million population per year. Regional activity data show that more than 50 surgeons currently undertake a workload of less than 500 thyroidectomies each year. Increased subspecialisation may be required to reduce costs and raise standards.     

Advances in the management of thyroid cancer

The incidence of thyroid cancer is rapidly increasing in the United States. A large number of incidentalomas are found during routine head and neck evaluations. The diagnostic workup still revolves around fine needle aspiration biopsy. Ultrasound guided fine needle aspiration biopsy is likely to yield the best results. Surgical resection offers the best treatment choice. Controversy continues in relation to total versus less than total thyroidectomy. The incidence of complications is inversely proportional to the extent of surgery and obviously related to the experience of the operating surgeon. The decision regarding the extent of thyroidectomy should be based on prognostic factors and risk groups. Prognostic factors are well defined, such as age, grade of the tumor, extrathyroidal extension, size, distant metastasis, and histology. Nodal metastasis has minimal implications. Based on prognostic factors, thyroid cancer can be divided into low, intermediate and high risk groups. In the high risk group and in selected intermediate risk patients, radioactive iodine dosimetry and ablation should be considered after total thyroidectomy. PET scanning and the use of recombinant TSH have been major advances in follow-up care for patients with thyroid cancer. Thyroglobulin appears to be a very good tumor marker for follow-up. No major breakthrough is noted in the management of anaplastic thyroid cancer, however, identification of RET mutation has been extremely helpful in evaluating the family members of the patient with medullary thyroid cancer with strong consideration given to total thyroidectomy.     

甲状腺乳头状微小癌124例的治疗和预后分析

目的 探讨甲状腺乳头状微小癌的治疗和预后.方法 回顾性分析1990年1月1日-1999年12月31日间在中山大学肿瘤防治中心头颈科接受治疗的124例甲状腺乳头状微小癌的临床和随访资料,对其进行Kaplan-Meier法单因素分析和Cox比例模型多因素分析.结果 124例甲状腺乳头状微小癌患者10年和15年生存率分别为94.9%、92.5%;单因素分析提示首诊时年龄≥35岁、有远处转移显著影响甲状腺乳头状微小癌患者的预后(均P＜0.05).而性别、是否为术中偶然发现、原发癌灶大小、淋巴结转移、是否为术后复发、手术范围等与患者预后无显著相关;多因素分析发现患者年龄≥35岁是影响甲状腺乳头状微小癌预后的独立因素(P=0.045).结论 甲状腺乳头状微小癌患者预后较好,但年龄≥35岁或有远处转移者预后较差.

Abstract：

Objective To investigate the treatment and prognosis of patients with papillary thyroid microcarcinoma. Methods The clinical and following-up data of 124 patients with papillary thyroid microcarcinoma treated at the Department of Head and Neck Surgery of Cancer Centre, SUN Yat-sen University from Jan 1990 to Dec 1999 were analyzed retrospectively for mortality and survival rate ( KaplanMeier). A multivariate analysis was performed in these patients by Cox proportional hazard model. Results The overall 10-year and 15-year survival rate of all 124 patients with papillary thyroid microcarcinoma were 94.9% and 92.5% respectively. The univariate analysis showed the prognostic factors significantly influencing the survival of patients included age (being worse for those of 35 years and older) at presentation, and the status of distant metastasis ( all P ＜ 0. 05 ) , while gender, incidentally found at surgery, the size of primary tumor, the status of neck lymph node metastasis, recurrence after a primary resection, and the extent of surgical resection did not significantly effect the prognosis. Multivariate analysis showed the age more than 35 years at presentation was an independent risk factor indicating worse prognosis (P = 0. 045 ). Conclusioas The prognosis of patients with papillary thyroid microcarcinoma is satisfactory, but that is poor for those patients 35 years old and up at presentation and with distant metastasis.