Key Points
Î Thyroid cancer is the most common endocrine malignancy. In 2014 it is
estimated that 96% of all new endocrine organ cancers will originate from
the thyroid gland, resulting in approximately 63,000 new cases and taking
the lives of 1890 patients.
Î Gross lymph node metastases can be present in approximately 35% of
patients with differentiated thyroid cancer (DTC).
Î Although lymph node metastases are common in DTC, death is not, and
the lack of a clear prognostic indication has led to controversy in the
management of cervical lymph nodes.
Î What may be more significant from a prognostic standpoint are lymph
node metastases that are larger than 3 cm, exhibit extranodal extension, or
metastasis present in more than five lymph nodes.
Î Identification of recurrent/persistent disease requires a team decision-
making process that includes the patient and physicians as to what, if
any, intervention should be performed to best control the disease while
minimizing morbidity.
Diagnosis
Table 1. Variables to Consider When Deciding How Best to
Manage a Differentiated Thyroid Cancer Patient with
Recurrent/Persistent Nodal Disease
Variables
Consider active
surveillance Consider surgery
Key considerations
Absolute size of lymph nodes (any
dimension)
a
• ≤0.8 cm (central
compartment)
• <1 cm (lateral
compartment)
• >0.8 cm (central
compartment)
• ≥1 cm (lateral
compartment)
Rate of lymph node growth on serial
imaging
Minimal/slow
(<3–5 mm/year)
Progressive
(>3–5 mm/year)
Vocal cord paralysis contralateral to the
paratracheal nodal basin where the positive
lymph node is located (next to only working
RLN)
Strongly consider
observation if node
is stable
Consider surgery if node
is increasing in size and
expertise for reoperative
surgery available
Known systemic metastases Progressive distant
disease outpacing
nodal metastasis
Stable distant metastasis,
but nodal disease
threatens vital structures
