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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Papillary microcarcinoma | Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series. | not mapped |
| Low risk | Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up. | not mapped |
| Intermediate and high risk | Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression. | not mapped |
| 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. | not mapped |