Are Total Thyroidectomy and Adjuvant Radioactive Iodine Treatment Required in All Patients with N1b Intermediate-High Risk Papillary Thyroid Carcinoma?
Authors' conclusion
RAI may improve RFS in selected patients with extensive nodal disease, but its routine use in all cN1b PTC cases may be unnecessary. Lobectomy or total thyroidectomy without RAI could be appropriate options in lower risk cN1b patients. Further studies are warranted to refine treatment strategies in intermediate-risk cN1b PTC.
Study context
- Population
- Patients with cT1–3N1bM0 PTC who underwent thyroidectomy with therapeutic lateral neck dissection, 2010–2022; 60.6% female, median age 58.0 years
- Participants
- 593 patients
- Exposure
- Lobectomy vs total thyroidectomy vs total thyroidectomy with RAI, each with lateral neck dissection
- Outcome
- Recurrence-free survival (RFS) and disease-specific survival (DSS)
- Follow-up
- Median 71.5 months
Methodological detailsmulticenter
- Multicenter
Main finding
As reported in the abstract
- Total thyroidectomy with RAI showed a trend toward worse recurrence-free survival (RFS), not statistically significant
- Between Lobectomy and Total thyroidectomy: P = 0.19
- Between Lobectomy and Total thyroidectomy: P = 0.40
- Comparison across lobectomy, total thyroidectomy and total thyroidectomy with RAI (Kaplan-Meier)
Observational data: associations, not effects.
Further findings
Independent risk factors for shorter RFS (multivariable Cox)
- Older age, HR per year
- 1.024 (CI 1.007-1.041, p = 0.006)
- Larger primary tumor size, HR per mm
- 1.026 (CI 1.012-1.041, p < 0.001)
- Larger metastatic lymph node size, HR per mm
- 1.020 (CI 1.003-1.036, p = 0.017)
- Extranodal extension, HR
- 1.741 (CI 1.046-2.898, p = 0.033)
Original publication
Are Total Thyroidectomy and Adjuvant Radioactive Iodine Treatment Required in All Patients with N1b Intermediate-High Risk Papillary Thyroid Carcinoma? Thyroid. Published 4 December 2025. doi:10.
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