{"entity":{"id":"papillary-thyroid-cancer","kind":"cancer","name":"Papillary thyroid cancer","aka":["Papillary thyroid carcinoma","PTC","Papillary microcarcinoma (under 1 cm)"],"tldr":"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.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Papillary_thyroid_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Papillary_thyroid_cancer"},{"label":"American Thyroid Association guidelines","url":"https://www.thyroid.org/professionals/ata-professional-guidelines/"}],"tags":["subtype-page"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"notes":[],"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)"],"standardOfCare":[{"setting":"Papillary microcarcinoma","approach":"Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series.","refs":["active-surveillance"]},{"setting":"Low risk","approach":"Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up.","refs":["thyroid"]},{"setting":"Intermediate and high risk","approach":"Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression.","refs":["radioiodine-therapy","tshr"]},{"setting":"Iodine-refractory advanced disease","approach":"Lenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E.","refs":["lenvatinib","sorafenib","selpercatinib","larotrectinib","entrectinib","dabrafenib","trametinib","rai-refractory"]}],"stateOfArt":["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."],"history":[{"year":1946,"title":"Radioactive iodine first treats thyroid cancer","refs":["radioiodine-therapy"]},{"year":2003,"title":"BRAF V600E found in papillary thyroid cancer","refs":["braf"]},{"year":2010,"title":"Kuma Hospital reports safe observation of microcarcinomas","note":"Ito and Miyauchi's series of over a thousand patients.","refs":[]},{"year":2014,"title":"Sorafenib approved for iodine-refractory disease (DECISION)","refs":["sorafenib"]},{"year":2015,"title":"Lenvatinib approved (SELECT)","refs":["lenvatinib"]},{"year":2022,"title":"ESTIMABL2 and IoN: no radioactive iodine for low-risk disease","note":"Both trials found equivalent outcomes without ablation.","refs":["radioiodine-therapy"]}],"pipeline":["dabrafenib","selpercatinib","larotrectinib"],"openProblems":["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."],"parent":"thyroid"},"route":"/cancers/papillary-thyroid-cancer/","neighbours":{"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"radioiodine-therapy","kind":"technology","name":"Radioiodine therapy and whole-body iodine scanning","route":"/technologies/radioiodine-therapy/"}],"target":[{"id":"braf","kind":"target","name":"BRAF","route":"/targets/braf/"},{"id":"tshr","kind":"target","name":"TSH receptor (TSHR)","route":"/targets/tshr/"}],"drug":[{"id":"dabrafenib","kind":"drug","name":"Dabrafenib","route":"/drugs/dabrafenib/"},{"id":"entrectinib","kind":"drug","name":"Entrectinib","route":"/drugs/entrectinib/"},{"id":"larotrectinib","kind":"drug","name":"Larotrectinib","route":"/drugs/larotrectinib/"},{"id":"lenvatinib","kind":"drug","name":"Lenvatinib","route":"/drugs/lenvatinib/"},{"id":"selpercatinib","kind":"drug","name":"Selpercatinib","route":"/drugs/selpercatinib/"},{"id":"sorafenib","kind":"drug","name":"Sorafenib","route":"/drugs/sorafenib/"},{"id":"trametinib","kind":"drug","name":"Trametinib","route":"/drugs/trametinib/"}],"cancer":[{"id":"thyroid","kind":"cancer","name":"Thyroid cancer","route":"/cancers/thyroid/"}],"term":[{"id":"rai-refractory","kind":"term","name":"Radioiodine-refractory (RAI-R) thyroid cancer","route":"/terms/rai-refractory/"}]}}