Treatment strategies for unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis: a narrative review.

BACKGROUND AND

OBJECTIVE

Unilateral papillary thyroid carcinoma (PTC) with ipsilateral cervical lymph-node metastasis carries intermediate-to-high recurrence risk. Although total thyroidectomy is conventionally recommended by multiple clinical guidelines, accumulating real‑world evidence has triggered ongoing debates regarding surgical extent, neck dissection scope, adjuvant radioactive iodine administration and molecular‑guided risk stratification. This narrative review intends to synthesize contemporary clinical evidence and provide references for individualized therapeutic decision‑making for this specific patient population.

METHODS

Literature was retrieved from PubMed, Embase, and Web of Science up to January 2026. English articles were screened by two reviewers through consensus. This is a narrative review without formal systematic-review procedures.

KEY CONTENT AND FINDINGS: For properly-selected patients, lobectomy provides similar oncological outcomes as total thyroidectomy with fewer complications. Unilateral central neck dissection plus selective lateral neck dissection balances tumour control and surgical morbidity. Aggressive pathological variants and concurrent B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E/telomerase reverse transcriptase (TERT) promoter dual mutations indicate elevated recurrence and mortality risk. Radioactive iodine (RAI) ablation ought to be determined by integrated risk assessment rather than routine application. Lymph‑node yield and lymph‑node ratio serve as key prognostic markers reflecting dissection quality and recurrence likelihood. Serum thyroglobulin, interfered by thyroglobulin antibodies, remains the core surveillance biomarker.

CONCLUSIONS

Risk‑stratified individualized management is strongly recommended for unilateral PTC patients with ipsilateral cervical lymph‑node metastasis. This review may facilitate clinical practice. Nevertheless, most available evidence comes from retrospective studies; further high‑quality prospective investigations are required to refine treatment strategies.