Low Risk | Intermediate Risk | High Risk |
Papillary thyroid cancer with all of the following: • No local or distant metastases • All the macroscopic tumor has been resected (R0) • No invasion of local and regional tissues • The tumor does not have an aggressive histology (aggressive histology’s include high-cell, insular tumors, columnar cell carcinoma, Hürthle cell carcinoma, follicular thyroid cancer, Hobnail variant) • Without vascular invasion • There is no uptake of I-131 outside the thyroid bed in the post-treatment examination • Clinical N0 or ≤5 pathological micro-metastases; N1 (<0.2 cm in the largest dimension) • Well-differentiated, encapsulated intra-thyroid follicular cancer • Well-differentiated intra-thyroid follicular thyroid cancer with capsular invasion and zero or minimal vascular invasion (<4 foci) • Intra-thyroid, unifocal or multifocal papillary micro-carcinoma, including mutated BRAF V600E (if known) | Any of the following present: • Microscopic invasion of peri-thyroid soft tissues • Cervical ganglionic metastases or avid I-131 metastatic foci in the neck on post-treatment examination after thyroid bed ablation • Tumor with aggressive histology or vascular invasion (aggressive histologies include high cell tumors, columnar, insular cell carcinoma, Hürthle cell carcinoma, follicular thyroid cancer, Hobnail variant) • Clinical N1 or >5 pathological N1 with all affected lymph nodes < 3 cm in the largest dimension • Multifocal papillary thyroid micro-carcinoma with extra thyroid extension and BRAF V600E mutation (if known) | Any of the following present: • Macroscopic tumor invasion • Incomplete tumor resection with macroscopic residual disease • Remote metastasis • Postoperative serum thyroglobulin suggestive of distant metastases • Pathological N1 with any metastatic lymph node ≥ 3 cm in the largest dimension • Follicular thyroid cancer with extensive vascular invasion (>4 foci of vascular invasion) |