LYMPH-NODE RECURRENCES OF DIFFERENTIATED THYROID CARCINOMAS

If the rate of lymph node involvement in differentiated thyroid carcinomas is very high, recurrences of node metastases are rare : less than 10 % in patients followed up for several decades. These relapses are observed essentially in papillary tumours, when at initial surgery there was major macroscopic lymph node involvement and when neck dissection was not systematic. Children and adolescents ara especially affected. After total thyroidectomy measurement of serum thyroglobulin is of great value in detecting tumour recurrences. Without total thyroidectomy the rate of nodal recurrences is perhaps underestimated, particularly in the central neck area where physical examination often fails. The treatment is based on surgery and 131 I therapy with priority to surgery. As the presence of nodal metastases does not appear to affect survival rate and nodal recurrences can be cured in most patients, prophylactic lymph node dissection may be questionable.