The Management of Recurrent/Persistent Well-Differentiated Thyroid Cancer in the Central Compartment

Part of the Head and Neck Cancer Clinics book series (HNCC)


The past decade has seen a marked increase within Canada in the incidence of well-differentiated thyroid cancer (WDTC). The incidence has increased 6.8 % per year in men since 1998 and 6.9 % per year in women since 2002 [1]. Once treated for WDTC, ≤20 % of patients are found to have evidence of recurrent disease [2, 3]. This recurrent disease can be seen within the central neck or elsewhere, in the lateral neck and distant sites. This chapter focuses on examining the current practice for detecting, preventing and treating recurrent WDTC in the central compartment of the neck. An overview is provided of both managing the central neck for an initial thyroid cancer operation as well as how the surgeon might diagnose and treat recurrence within it.


Thyroid Cancer Papillary Thyroid Carcinoma Parathyroid Gland Recurrent Laryngeal Nerve Recurrent Laryngeal Nerve Palsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2012. Toronto: Canadian Cancer Society; 2012.Google Scholar
  2. 2.
    Enewold L, Zhu K, Ron E, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev. 2009;18:784–91.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.Google Scholar
  4. 4.
    Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg. 2012;255:777–83.PubMedCrossRefGoogle Scholar
  5. 5.
    Randolph G, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension: ATA Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery. Thyroid. 2012;10.Google Scholar
  6. 6.
    Steward DL. Update in utility of secondary node dissection for papillary thyroid cancer. J Clin Endocrinol Metab. 2012;97:3393–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Lee KE, Chung IY, Kang E, et al. Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer: Patterns and predictive factors of nodal metastasis. Head Neck. 2013;35:672–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Mulla M, Schulte KM. Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the central compartment. Clin Endocrinol (Oxf). 2012;76:131–6.CrossRefGoogle Scholar
  9. 9.
    Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140:1000–100.PubMedCrossRefGoogle Scholar
  10. 10.
    Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193:871–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Hughes DT, White ML, Miller BS, et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148:1100–6; discussion 1006–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Shindo M, Wu JC, Park EE, et al. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2006;132:650–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Cooper DS, Doherty GM, Haugen BR, et al. The American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.Google Scholar
  14. 14.
    Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg. 2002;26:1013–6.PubMedCrossRefGoogle Scholar
  15. 15.
    White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31:895–904.PubMedCrossRefGoogle Scholar
  16. 16.
    Hay ID, Bergstralh EJ, Goellner JR, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114:1050–8.PubMedGoogle Scholar
  17. 17.
    Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104:947–53.PubMedGoogle Scholar
  18. 18.
    DeGroot LJ, Kaplan EL, McCormick M, et al. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990;71:414–24.PubMedCrossRefGoogle Scholar
  19. 19.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–28.PubMedCrossRefGoogle Scholar
  20. 20.
    Shaha AR, Loree TR, Shah JP. Intermediate-risk group for differentiated carcinoma of the thyroid. Surgery. 1994;116:1036–41.PubMedGoogle Scholar
  21. 21.
    Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: Results of a study on 1087 patients and review of the literature. Thyroid. 2012;22:911–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Palestini N, Borasi A, Cestino L, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008;393:693–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Lim YC, Koo BS. Predictive factors of skip metastases to lateral neck compartment leaping central neck compartment in papillary thyroid carcinoma. Oral Oncol. 2012;48:262–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Lin JD, Hsueh C, Chao TC. Early recurrence of papillary and follicular thyroid carcinoma predicts a worse outcome. Thyroid. 2009;19:1053–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Alvarado R, Sywak MS, Delbridge L, et al. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? Surgery. 2009;145:514–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Choi JW, Lee JH, Baek JH, et al. Diagnostic accuracy of ultrasound and 18-F-FDG PET or PET/CT for patients with suspected recurrent papillary thyroid carcinoma. Ultrasound Med Biol. 2010;36:1608–15.PubMedCrossRefGoogle Scholar
  27. 27.
    Qiu ZL, Xu YH, Song HJ, et al. Localization and identification of parapharyngeal metastases from differentiated thyroid carcinoma by 131I-SPECT/CT. Head Neck. 2011;33:171–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Rubello D, Salvatori M, Ardito G, et al. Iodine-131 radio-guided surgery in differentiated thyroid cancer: Outcome on 31 patients and review of the literature. Biomed Pharmacother. 2007;61:477–81.PubMedCrossRefGoogle Scholar
  29. 29.
    Soprani F, Bondi F, Puccetti M, et al. Charcoal tattoo localization for differentiated thyroid cancer recurrence in the central compartment of the neck. Acta Otorhinolaryngol Ital. 2012;32:87–92.PubMedCentralPubMedGoogle Scholar
  30. 30.
    Harari A, Sippel RS, Goldstein R, et al. Successful localization of recurrent thyroid cancer in reoperative neck surgery using ultrasound-guided methylene blue dye injection. J Am Coll Surg. 2012;215:555–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Erbil Y, Sari S, Adcaodlu O, et al. Radio-guided excision of metastatic lymph nodes in thyroid carcinoma: a safe technique for previously operated neck compartments. World J Surg. 2010;34:2581–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Schuff KG, Weber SM, Givi B, et al. Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope. 2008;118:768–75.PubMedCrossRefGoogle Scholar
  33. 33.
    Benbassat CA, Mechlis-Frish S, Guttmann H, et al. Current concepts in the follow-up of patients with differentiated thyroid cancer. Isr Med Assoc J. 2007;9:540–5.Google Scholar
  34. 34.
    Clayman GL, Shellenberger TD, Ginsberg LE, et al. Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck. 2009;31:1152–63.PubMedCrossRefGoogle Scholar
  35. 35.
    Yoon JH, Kim JY, Moon HJ, et al. Contribution of computed tomography to ultrasound in predicting lateral lymph node metastasis in patients with papillary thyroid carcinoma. Ann Surg Oncol. 2011;18:1734–41.PubMedCrossRefGoogle Scholar
  36. 36.
    Moley JF, Lairmore TC, Doherty GM, et al. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery. 1999;126:673–7; discussion 677–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Heilo A, Sigstad E, Fagerlid KH, et al. Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab. 2011;96:2750–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Kim BM, Kim MJ, Kim EK, et al. Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol. 2008;18:835–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Lewis BD, Hay ID, Charboneau JW, et al. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178:699–704.PubMedCrossRefGoogle Scholar
  40. 40.
    Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery. 1992;111:604–9.PubMedGoogle Scholar
  41. 41.
    Kim MK, Mandel SH, Baloch Z, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg. 2004;130:1214–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Shah MD, Harris LD, Nassif RG, et al. Efficacy and safety of central compartment neck dissection for recurrent thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138:33–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Roh JL, Kim JM, Park CI. Central compartment reoperation for recurrent/persistent differentiated thyroid cancer: patterns of recurrence, morbidity, and prediction of postoperative hypocalcemia. Ann Surg Oncol. 2011;18:1312–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Pai SI, Tufano RP. Reoperation for recurrent/persistent well-differentiated thyroid cancer. Otolaryngol Clin North Am. 2010;43:353–63.PubMedCrossRefGoogle Scholar
  45. 45.
    Tufano RP, Bishop J, Wu G. Reoperative central compartment dissection for patients with recurrent/persistent papillary thyroid cancer: efficacy, safety, and the association of the BRAF mutation. Laryngoscope. 2012;122:1634–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Hughes DT, Laird AM, Miller BS, et al. Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. Ann Surg Oncol. 2012;19:2951–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Farrag TY, Agrawal N, Sheth S, et al. Algorithm for safe and effective reoperative thyroid bed surgery for recurrent/persistent papillary thyroid carcinoma. Head Neck. 2007;29:1069–74.PubMedCrossRefGoogle Scholar
  48. 48.
    Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145:272–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Lang BH, Lee GC, Ng CP, et al. Evaluating the morbidity and efficacy of reoperative surgery in the central compartment for persistent/recurrent papillary thyroid carcinoma. World J Surg. 2013;37:2853–9.PubMedCrossRefGoogle Scholar

Copyright information

© K. Alok Pathak, Richard W. Nason, Janice L. Pasieka, Rehan Kazi, Raghav C. Dwivedi 2015

Authors and Affiliations

  1. 1.Division of General SurgeryToronto General Hospital, University Health NetworkTorontoCanada

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