Small papillary cancer of the thyroid (SPC), conventionally defined as a tumor less than 10 mm in diameter, today is considered quite interesting. In fact, autoptic incidence is higher than reported in clinical series. Generally SPC has a good evolution, however, particularly aggressive forms are described. The Authors review Literature data and evaluate pathogenesis and diagnostic problems of SPC. The Authors agree on a multidisciplinary therapeutic protocol in which total thyroidectomy is the elective intervention associated, in selected patients, to metabolic radiotherapy.