In our previous report [
6] we recommended TSH suppression to all postoperative PMC patients, but the majority of patients who did not have postoperative hypothyroidism discontinued medication within a few years. We evaluated whether patients who discontinued TSH suppression had a higher incidence of recurrence. We found that there was no statistically significant difference. Because most patients with one intact thyroid lobe have normal levels of T4, we discontinued the practice of prescribing thyroid hormones to postoperative patients with normal thyroid function. Recently, it has been reported that TSH may not be the dominant growth factor for benign and malignant thyroid tumors [
16]. This finding confirms our observation. We do not use radioactive iodine unless there is evidence of distant metastasis. In sum, our only postoperative management is to observe the patient once a year with ultrasonography and, if necessary, fine-needle aspiration cytology as well as checking serum thyroglobulin levels. Pelizzo et al. [
17] uses more aggressive treatments, including total thyroidectomy and radioactive iodine treatment. However, their recurrence rate is higher than ours within a shorter follow-up period. There are many experts who treat PMC with the same or slightly less aggressive regimen as used for clinical papillary carcinoma [
18,
19]. Furlan et al. [
20] use near total thyroidectomy and optionally consider radioactive ablation. We consider thyroid lobectomy or subtotal thyroidectomy without radioactive iodine ablation of residual thyroid tissue as sufficient therapy once unifocal PMC has been established. Similarly, the Institute Gustave-Roussey group believe that loboisthmectomy is the treatment of choice [
21]. Peizzo et al. [
17] recommended lobectomy plus TSH suppression in 1990. Rodriguez et al. [
22] recommended lobectomy alone. However, the treatment of incidental multifocal PMC is still controversial. When other papillary microcarcinomas are found during surgery, the Institute Gustave-Roussey group perform total thyroidectomy. However, incidental PMC is often not proven until postoperative histopathology is performed.