The prognostic significance of lymph node metastases in patients with papillary thyroid carcinoma (PTC) is still controversial. However, lateral nodal involvement may require more aggressive surgical intervention such as central and lateral neck dissection, for the associated increased rates of recurrence and distant metastases. The therapeutic neck dissection is performed with least morbidity at the initial operation. The most common procedure today implies comprehensive functional lateral neck dissection (level II to V) (FLND), preserving the sternocleidomastoid muscle, the accessory nerve, and the internal jugular vein.

Among 2720 patients who underwent thyroidectomy for differentiated thyroid carcinoma in our Division, a complete central neck dissection (CND) was carried out in 231 patients and a FLND was performed in 157 patients. The mean number of removed lymph nodes was 14 +/- 6.2 (range: 6-33) in CND and 36 +/- 18.7 (range: 10-77) in FLND.

Herein we reported a case of 53 year old female who underwent total thyroidectomy, CND and left FLND for a pT1m papillary thyroid carcinoma. The operative time was 240 minutes. Lymph node metastases were found in 5 off 11 lymph nodes removed in central compartment and in 10 off 63 lymph nodes removed in left lateral compartment. The postoperative stay was 4 days. A transient postoperative hypocalcemias was observed. The serum thyroglobulin off LT4 (TSH 99.27 µUI/ml) was <0.1 ng/ml. Radioiodine uptake off LT4 was < 1%.

Neck dissection including central and ipsilateral lateral compartments may be the optimal treatment for the patients with lateral cervical metastasis from PTC.