The dartmouth study on papillary thyroid cancer seemed to imply that a watch and wait approach may be appropriate vs.a tt or other treatment. is it too risky?

Yes not that simple: Incidence of thyroid cancers jumped 100% due to awareness and diagnostic techniques, the study is for localized papillary cancers only 99% of treated survived vs 97% in untreated group , translates to 2 deaths in 100 , no body wants to die. Unlike other cancers like breast , ovary etc don't have to rush for treatment the movement diagnosis is made.

Maybe: Depends on many factors. 1) patient age - as one ages papillary cancer becomes more aggressive, 2) size of tumor - < 1 cm tend to behave benignly, 3) what is watch and wait? My friend blake cady showed, when he was in boston, that there is no advantage to total thyroidectomy vs. Lobectomy for early thyroid ca (small, no extrathyroidal, young pt). Would not recommend no thyroid surgery at all.

Not recommended: Even though papillary thyroid cancer is non-aggressive, it can kill you. It's after all a cancer. Thyroid surgery is now safer, especially in the hand of an experienced surgeon. The risk is much less than leaving a cancer in for a watch and wait aproach. Worst thing to do is to wait 10 yrs until you are now older with more medical problems and now have to go for surgery.

It depends: This is the newest thinking on the subject, however, it's hard to think of a cancer in your body and not doing something about it. There are plenty of good studies for the gold standards treatment protocols. It really depends on the physician who is taking care of you and how comfortable they feel with each approach.