Thyroid cancer - papillary carcinoma

About 85% of all thyroid cancers diagnosed in the United States are the papillary carcinoma type. It is more common in women than in men. It may occur in childhood, but is most often seen in adults between ages 20 and 60.

The cause of this cancer is not known. A genetic variant or family history of the disease may be a risk factor.

Radiation exposure increases the risk for developing thyroid cancer. Exposure may occur from:

• High-dose external radiation treatments to the neck, especially during childhood, used to treat childhood cancer or some noncancerous childhood conditions
• Radiation exposure from nuclear plant disasters

Radiation given through a vein (through an IV) during medical tests and treatments does not increase the risk for developing thyroid cancer.

Thyroid cancer often begins as a small lump (nodule) in the thyroid gland.

While some small lumps may be cancer, most (90%) thyroid nodules are not cancerous.

Most of the time, there are no symptoms from the nodule.

If you have a lump on your thyroid, your health care provider may order the following tests:

• Blood tests.
• Ultrasound of the thyroid gland and neck region.
• CT scan of the neck or MRI to determine the size of the tumor.
• An exam of the airway with a fiberoptic scope (laryngoscopy) may show a paralyzed vocal cord.
• Fine needle aspiration biopsy (FNAB) to determine if the lump is cancerous. FNAB may be performed if the ultrasound shows that the lump is less than 0.4 inches (in) or 1 centimeter (cm) in size.

Genetic testing may be done on the biopsy sample to see what genetic changes (mutations) may be present. Knowing this may help guide treatment recommendations.

Thyroid function tests are often normal in people with thyroid cancer.

Thyroid cancer treatment may include:

• Surgery
• Radioactive iodine therapy
• Thyroid suppression therapy (thyroid hormone replacement therapy)
• External beam radiation therapy (EBRT)

Surgery is done to remove as much of the cancer as possible. The bigger the lump, the more of the thyroid gland must be removed. Often, the entire gland is taken out.

After the surgery, you may receive radioiodine therapy, which is often taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images clearer, so doctors can see if there is any cancer left behind or if it comes back later.

Further management of your cancer will depend on many factors such as:

• Size of any tumor present
• Location of the tumor
• Growth rate of the tumor
• Symptoms you may have
• Your own preferences

If surgery is not an option, external radiation therapy can be useful.

After surgery or radioiodine therapy, you will need to take medicine called levothyroxine for the rest of your life. This replaces the hormone the thyroid would normally make.

Your provider will likely have you take a blood test every several months to check thyroid hormone levels. Other follow-up tests that may be done after treatment for thyroid cancer include:

• Ultrasound of the thyroid
• An imaging test called a radioactive iodine (I-131) uptake scan
• Repeat FNAB

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

The survival rate for papillary thyroid cancer is excellent. More than 95% of adults with this cancer survive at least 5 years. The prognosis is better for people who are younger than 40 and for those with smaller tumors.

The following factors may decrease the survival rate:

• Older than 55 years of age
• Cancer that has spread to distant parts of the body
• Cancer that has spread to soft tissue around the thyroid
• Large tumor

Complications include:

• Accidental removal of the parathyroid glands, which help regulate blood calcium levels
• Damage to the nerve that controls the vocal cords
• Spreading of cancer to lymph nodes
• Spreading of cancer to other sites (metastasis) - lung and bone are the most common sites if this occurs

Contact your provider if you have a lump in your neck.

Papillary carcinoma of the thyroid; Papillary thyroid cancer; Papillary thyroid carcinoma

Asban A, Patel AJ, Reddy S, Wang T, Balentine CJ, Chen H. Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 68.

National Cancer Institute website. Thyroid cancer treatment (PDQ) - health professional version. www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq. Updated May 9, 2025. Accessed March 31, 2026.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): thyroid carcinoma. Version 1.2025. www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Updated March 27, 2025. Accessed March 31, 2026.

Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.

Ringel MD, Sosa JA, Baloch Z, et al. 2025 American Thyroid Association management guidelines for adults with differentiated thyroid cancer. Thyroid. 2025;35(8):841-985. PMID: 40844370 pubmed.ncbi.nlm.nih.gov/ 40844370/.

Updated by: Warren Brenner, MD, Oncologist, Lynn Cancer Institute, Boca Raton, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.