To evaluate tumor recurrence after total thyroidectomy in patients with single papillary carcinoma with size <or= 2 cm and restricted to the thyroid, we studied 136 consecutive patients divided into two groups according to postoperative management: no ablative therapy (n = 42) (group 1) and ablation with 1.1 GBq (n = 36) or 3.7 GBq (131)I (n = 58) (group 2). None of the patients were submitted to central-compartment (VI level) neck dissection. Thyroid-stimulating hormone (TSH) levels were > 0.5 mIU/L in >or=50% of the measurements in all patients. Complete remission (stimulated thyroglobulin (Tg) <or= 1 ng/mL, undetectable antithyroglobulin antibodies (TgAb), and negative imaging methods) was observed in 83% of the patients in group 1 and in 89% in group 2 (p = 0.4), and none of the patients presented apparent disease during follow-up (mean: 6 years). Posttherapy whole-body scanning was available in 74 patients, and none of them showed ectopic uptake. TgAb were still present in 7.1% of the patients in group 1 and in 8.5% in group 2 (p > 0.05). Six patients who still had stimulated Tg > 1 ng/mL (<5 ng/mL) showed a >50% decrease in comparison with Tg measured 12-24 months earlier. In conclusion, we suggest a more conservative approach with respect to central-compartment neck dissection, postoperative (131)I, and suppressive therapy in patients with small tumors restricted to the thyroid.