Papillary Thyroid Carcinoma with Central Lymph Node Metastases
Lymph nodal involvement in papillary thyroid carcinoma (PTC) is very common. Preoperative neck ultrasonography (USG) allows for the early detection of nonpalpable cervical lymph node metastasis prior to thyroidectomy in patients with FNAB-proven or suspected thyroid cancer. In patients with clinically involved central nodes, therapeutic central compartment (level VI) neck dissection should be performed. Lateral neck dissection performed for macroscopic PTC metastases should be the selective neck dissection of levels IIa, III, IV, and Vb. We present a 38-year-old female patient of unilateral PTC with central and ipsilateral lateral lymph node metastasis who underwent total thyroidectomy and bilateral central and ipsilateral lateral lymph node dissection followed by radioactive iodine ablation (RAI) treatment. Postoperative RAI adjuvant therapy should be considered in ATA intermediate-/high-risk level patients. In PTC patients, no biochemical, clinical, or radiological evidence of tumor during the follow-up after total thyroidectomy and RAI treatment is defined as excellent response to treatment. The rate of recurrence ranges between 1 and 4% in patients with excellent response. In intermediate-risk patients who are subsequently reclassified into excellent response category, non-stimulated thyroglobulin assays and neck USG at 12–24-month intervals are considered to be appropriate in the follow-up.
KeywordsPapillary thyroid carcinoma Central lymph node metastases Lymph node dissection
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