Recurrence of papillary thyroid carcinoma from the residual pyramidal lobe: a case report and literature review

Rationale: Recurrence of papillary thyroid carcinoma (PTC) usually requires a second operation, which carries a high complication rate, especially if central neck dissection (CND) is necessary. Recurrent PTC from pyramidal lobe is a rare entity, which is mainly due to non-standardized operation. However, literature on this topic is limited. Patients concerns: Here, we present a case of a 46-year-old woman with the recurrence of PTC from the thyroid pyramidal lobe (PL) following two thyroid operations. Diagnoses: The final pathological result revealed recurrent PTC from the residual pyramidal lobe tissue. Interventions: The resection of the residual PL, the pretracheal nodes and the Delphian nodes plus intraoperative neuromonitoring (IONM) were performed, followed by TSH suppression therapy. Outcomes: After two previous operations, the recurrent PTC from the residual pyramidal lobe tissue was completed resected. Until the latest follow-up, the patient had an excellent response to the third intervention. Lessons: Complete excision of the PL is mandatory in patients with PTC if thyroid surgery was indicated, considering the potential risk of recurrence from the PL and the high incidence of multifocality of PTC.