# Papillary thyroid cancer

Source: https://onco.cc/cancers/papillary-thyroid-cancer/  
OnCo record `papillary-thyroid-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Papillary thyroid cancer is the commonest and most curable thyroid cancer. Most people are treated with surgery, some with radioactive iodine afterwards, and many small tumours can simply be watched. Only the rare tumours that stop taking up iodine need targeted drugs.

## Summary

Papillary thyroid cancer arises from the follicular cells and often spreads to neck lymph nodes but rarely kills. About 60 percent carry a BRAF V600E mutation and others RET or NTRK fusions or RAS mutations. Treatment is lobectomy or total thyroidectomy, with radioactive iodine reserved for intermediate- and high-risk disease after the ESTIMABL2 and IoN trials showed low-risk patients do as well without it; TSH suppression with levothyroxine and thyroglobulin monitoring follow. Japanese studies established that papillary microcarcinomas under a centimetre can be kept under active surveillance, and guidelines now allow it. The minority whose recurrent or metastatic disease no longer takes up iodine are treated with lenvatinib or sorafenib, or with selpercatinib, larotrectinib or dabrafenib-trametinib when the matching alteration is found.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Papillary thyroid carcinoma; PTC; Papillary microcarcinoma (under 1 cm)
- Tags: subtype-page
- Group: endocrine
- Burden: About four in five thyroid cancers; incidence tripled over three decades in many countries mainly through ultrasound detection of small tumours, while deaths barely changed; more than nine in ten patients are alive at ten years.
- Subtypes: Classic papillary; Follicular variant; Tall cell, columnar and hobnail variants (more aggressive); Papillary microcarcinoma (under 1 cm); Diffuse sclerosing variant
- Biomarkers: BRAF V600E (about 60 percent); RET and NTRK fusions; TERT promoter mutation (worse outlook, especially with BRAF); Thyroglobulin after surgery; ATA risk category (low, intermediate, high)

## Standard of care

- Papillary microcarcinoma: Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series. ([Active surveillance](https://onco.cc/technologies/active-surveillance/))
- Low risk: Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up. ([Thyroid cancer](https://onco.cc/cancers/thyroid/))
- Intermediate and high risk: Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression. ([Radioiodine therapy and whole-body iodine scanning](https://onco.cc/technologies/radioiodine-therapy/), [TSH receptor (TSHR)](https://onco.cc/targets/tshr/))
- Iodine-refractory advanced disease: Lenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E. ([Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Sorafenib](https://onco.cc/drugs/sorafenib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Trametinib](https://onco.cc/drugs/trametinib/), [Radioiodine-refractory (RAI-R) thyroid cancer](https://onco.cc/terms/rai-refractory/))

## State of the art

- Two randomised trials showed that low-risk patients can skip radioactive iodine without harm, ending decades of routine ablation.
- Active surveillance of microcarcinomas is accepted practice and is reducing overtreatment.
- Fusion-directed drugs give deep, durable responses in the few iodine-refractory patients who carry RET or NTRK fusions.
- Redifferentiation with BRAF or MEK inhibitors can restore iodine uptake in some refractory tumours.

## Open problems

- Overdiagnosis and overtreatment of small tumours found by imaging.
- Which intermediate-risk patients truly benefit from radioactive iodine.
- Resistance to kinase inhibitors in refractory disease.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Papillary_thyroid_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Papillary_thyroid_cancer
- American Thyroid Association guidelines: https://www.thyroid.org/professionals/ata-professional-guidelines/

## Connected records

- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Radioiodine therapy and whole-body iodine scanning](https://onco.cc/technologies/radioiodine-therapy/)
- targets: [BRAF](https://onco.cc/targets/braf/), [TSH receptor (TSHR)](https://onco.cc/targets/tshr/)
- drugs: [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Sorafenib](https://onco.cc/drugs/sorafenib/), [Trametinib](https://onco.cc/drugs/trametinib/)
- cancers: [Thyroid cancer](https://onco.cc/cancers/thyroid/)
- terms: [Radioiodine-refractory (RAI-R) thyroid cancer](https://onco.cc/terms/rai-refractory/)

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JSON: https://onco.cc/api/v1/entities/papillary-thyroid-cancer.json