Thyroid Cancer No Surgery 2018: You are 25 Years 0ld and Told You Have a Small Micro-Papillary Thyroid Cancer.

Thyroid Cancer No Surgery 2018: You are 25 Years 0ld and Told You Have a Small Micro-Papillary Thyroid Cancer.

Thyroid Cancer No Surgery 2018: You are 25 Years 0ld and Told You Have a Small Micro-Papillary Thyroid Cancer.

Thyroid Cancer No Surgery 2018: You are 25 Years Old and Told You Have a Small Micro-Papillary Thyroid Cancer.

What are the alternatives to an immediate  thyroidectomy or long term active surveillance?

Many patients don’t like either options and look for a third option.

In 2018 there is a third option of all ages with micro-papillary thyroid cancer. Older patients do better with AS than those <40 years.

Active surveillance may be the treatment for micro-papillary cancer but many will not be happy and opt of surgery at first. Those with a desire not to have surgery and don’t want a thyroid cancer in their neck for years can now consider thyroid cancer ablation therapy at the first sign of the disease and if they pass strict rules to be a candidate Active surveillance, but refuse to sign up.

Mayo Clinic is offering and studying the third path with ethanol ablation of the primary 10-15 mm cancers.

Santa Monica Thyroid Center’s private practice Richard Guttler is also offering ethanol ablation to selected cases.

Dr.Guttler treating a recurrent lateral neck lymph node papillary thyroid cancer with ethanol PEI. Same method can also treat primary micro-papillary thyroid cancers as a third option from surgery or active surveillance.



The Korean group headed by Dr. JH Baek is also looking into Thyroid RFA therapy of primary micro-papillary.

Call me at 310-393-8860 for details on all three programs.


Richard Guttler MD,FACE,ECNU

Interventional Thyroidologist



Reference and my discussion to follow.

Insights into the Management of Papillary Thyroid Micro-carcinoma

Thyroid 28 ( 1) 2018 23-31

Miyauchi et al

Dr.G.’s Comments:

  1. You are told it is extremely unlikely it will grow the 3 mm to trigger a rescue surgery ( 5% ).
  2. They recommend Active surveillance.
  3. This means a lifetime of cancer follow up visits in 95% of the cases.
  4. You are young and do not look forward to 40+ years of examinations.
  5. Also the thought of a cancer in your neck for during your lifetime is also troubling.
  6. The alternative of thyroid surgery is also troubling as it is a major surgery with many complications and post op recovery problems and is costly.
  7. Unfavorable events with surgery were vocal cord paralysis, hypoparathyroidism, need to take thyroid hormone substitution therapy for life,and a neck scar.
  8. Rising health care costs due in part to thyroid surgery is 1.6 billion now and estimated to go to 3.5 billion by 2030.
  9. 20-40 year old patients need to remove the micro-cancer with surgery.
  10. Is there another way to destroy the small cancer without a full thyroidectomy?
  11. The answer is yes.
  12. The ablation of the micro-papillary while it is 10 mm when first diagnosed may be a third path to surgery or active surveillance for patients of all ages who do not want surgery or long term follow up with a cancer in their neck.
  13. There are two methods for ablation of primary micro-papillary cancers
  14. Ethanol Ablation PEI has been shown effective in ablation in studies presented at two national and international meetings by the Mayo clinic group headed by Dr.Ian Hay.
  15. 0fe30717-b204-4d8a-a69a-9350db4b50a4
  16. Thyroid Radiofrequency Ablation RFA has been studied in Korea for the same indications.
  17. Professor Baek in Seoul Korea  at Asan Medical Center.
  18. baek


  • Eman March 14, 2018 10:40 am

    i am 25 years old , few days a go i discovered a nodule in my thyroid left part its thick walled about 2-3 CM doc recommending its 90% non cancerous however i am to do fine needle aspiration test v soon in order for me to make sure its non cancerous ; doc is also recommending a surgery to remove the whole gland ; i have done thyroid tests it shows hormones are fine there is no problem with the hormones that the gland produce; my question is : how necessary is the surgery in case the tumor is non cancerous also if i delay the surgery for one year can it affect me by any chance negatively ? can the tumor turn from non cancerous to cancerous ?

    • Dr Guttler March 17, 2018 6:27 am

      With A good biopsy and molecular markers the nodule will be benign and not turn into cancer.
      Do not have surgery until you have a complete evaluation by expert thyroidologist. You may
      not need it or even have half instead of the whole thyroid removed.


Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860