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Papillary thyroid carcinoma — MCCQE Part 1 MCQ

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ModerateNeck MassPapillary thyroid carcinomaMCCQE Part 1

A 45-year-old woman has a 1.5 cm papillary thyroid carcinoma confined to the right thyroid lobe. Neck ultrasound also shows a suspicious 2.0 cm right level IV lymph node; FNA of that node confirms metastatic papillary carcinoma. There is no distant metastatic disease. According to the 2025 ATA guideline, which initial operation is most appropriate?

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Correct answer: D — Total thyroidectomy with ipsilateral central and therapeutic lateral neck dissections

FNA-proven lateral cervical nodal metastasis makes this clinically node-positive lateral-compartment disease (cN1b), not a low-risk cN0 tumour suitable for lobectomy alone. The 2025 ATA guideline specifies total thyroidectomy for cN1 disease. It also recommends that ipsilateral therapeutic central-compartment dissection accompany thyroidectomy and lateral-compartment dissection for cN1b disease, and it strongly recommends therapeutic lateral compartmental dissection for biopsy-proven lateral adenopathy. Thyroidectomy alone leaves known regional disease untreated; lobectomy is inadequate in this setting, and removing only the lateral nodes leaves the thyroid primary. Therefore, total thyroidectomy with the indicated central and lateral compartment-oriented dissections is the best listed operation.

Reference: Ringel MD et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer, corrected February 2026. https://journals.sagepub.com/doi/pdf/10.1177/10507256251363120