What should we do? Papillary thyroid carcinoma in a lymph node but normal thyroid tissue - how should we proceed?

Papillary cell carcinoma of the thyroid is a relatively indolent disease, u sually presenting as an asymptomatic mass in the thyroid gland that is eith er noted by the patient or diagnosed at routine clinical examination. Altho ugh the prognosis is generally good there are a number of controversies in the management of this condition, The significance of age at presentation, size of the tumour and the presence of lymph node metastasis are still disp uted, We present the unusual case of a woman found to have papillary cell t hyroid carcinoma within a lymph node during a cosmetic thyroid lobectomy. T he thyroid tissue removed was not found to contain tumour, We describe the evidence behind the decision to proceed to total thyroidectomy and the find ing of a tiny focus of papillary cell thyroid carcinoma within the contrala teral lobe.