The positivity rate for tumors <1 cm was 27%. Discussion Malignant tumors of the thyroid fit 11th place among all malignancies and the first of the endocrine system. The mortality, elevated to the forms anaplastic, is rather low for the differentiated. The rare deaths are recorded in elderly patients with aggressive forms poorly the site differentiated or locally (7, 8). In order to facilitate the choices of the appropriate treatments other prognostic variables are taken into considerations. These can be relating to patient (age, sex), tumor (size, multicentricity, histologic grade, histologic type, extrathyroidal invasion, lymph node metastasis, distant metastasis) or surgical procedure (complete and incomplete resection).

These variables are then represented in the most common classification systems: AMES (Age, Metastasis, Extension, Size), AGES (Age, Grade, Extension, Size), MACE (Metastasis, Age, Completeness, Invasion, Size) and TNM, at the end of a proper identification of subjects at low and high risk. The role of the different prognostic factors in the definition of risk groups varies substantially between the authors (2�C19). Shaha has catalogued all patients in low, medium and high risk with a mortality rate of 1%, respectively, 13%, 43% respectively (2). The risk can be discriminatory factor in choosing the surgical and post-surgical therapeutic strategy. The correct stratification of the risk can be made only on surgical specimen (20). Molecular analysis of FNAB samples or surgical specimen provide useful information (21, 22).

Genetic alterations (BRAF, ret / PTC, RAS, TRK for papillary carcinoma and RAS, PAX8-PPARy, PIK3CA, PTEN for follicular carcinoma) are meaningful indicators of the tumor aggressiveness (23�C42). In micro carcinomas the percentage of metastatic spread to lymph nodes of the central compartment reaches up to 40% (3, 4). Percentage of recurrence of disease, in relation to age (> or <50 years), is not significantly different from tumors above and below 1 cm (5�C7). If literature is concordant for the lymphadenectomy of level VI only in the presence of pathological lymph nodes, controversial is the opinion on total thyroidectomy versus loboistmectomia (5, 15). Everyone agrees on the total thyroidectomy in patients at high risk, in youth with lymphadenopathy, in bulky tumors and/or extracapsular disease and with cytological diagnosis of poorly differentiated cancer (13, 14, 16, 20, 23, 25).

For the new guidelines (20), total thyroidectomy is the most appropriate treatment for nodules > 1 cm with FNAB-positive for neoplasia in the presence of other nodules or contralateral lymph node metastases and/or distant Batimastat metastases, with a history of neck irradiation or family history of thyroid cancer, for patients older than 45 years.