MicroRNAs in thyroid cancer with focus on medullary thyroid carcinoma:potential therapeutic targets and diagnostic/prognostic markers and web based tools

This review aimed to describe the inculpation of microRNAs(miRNAs)in thyroid cancer(TC)and its subtypes,mainly medullary thyroid carcinoma(MTC),and to outline web-based tools and databases for bioinformatics analysis of miRNAs in TC.Additionally,the capacity of miRNAs to serve as therapeutic targets and biomarkers in TC management will be discussed.This review is based on a literature search of relevant articles on the role of miRNAs in TC and its subtypes,mainly MTC.Additionally,web-based tools and databases for bioinformatics analysis of miRNAs in TC were identified and described.MiRNAs can perform as oncomiRs or antioncoges,relying on the target mRNAs they regulate.MiRNA replacement therapy using miRNA mimics or antimiRs that aim to suppress the function of certain miRNAs can be applied to correct miRNAs aberrantly expressed in diseases,particularly in cancer.MiRNAs are involved in the modulation of fundamental pathways related to cancer,resembling cell cycle checkpoints and DNA repair pathways.MiRNAs are also rather stable and can reliably be detected in different types of biological materials,rendering them favorable diagnosis and prognosis biomarkers as well.MiRNAs have emerged as promising tools for evaluating medical outcomes in TC and as possible therapeutic targets.The contribution of miRNAs in thyroid cancer,particularly MTC,is an active area of research,and the utility of web applications and databases for the biological data analysis of miRNAs in TC is becoming increasingly important.

Childhood Papillary Thyroid Carcinoma: A Case Report

Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.

Studies on surgical methods for sporadic micromedullary thyroid carcinoma

Background:To observe the changes in serum calcitonin levels after application of different surgical methods for primary medullary thyroid microcarcinoma(MTMC)and explore a more reasonable surgical method.Methods:A retrospective analysis of 36 patients with MTMC,16 in group A and 20 in group B,was performed.In group A,tumors were single and confined to the thyroid lobe,and thyroid lobectomy with isthmusectomy was performed.In group B,tumors were in the isthmus or invaded the thyroid gland,or there were multiple foci in bilateral lobes,and patients with primary foci underwent total thyroidectomy.The median follow-up time was 3.6 years.Clinical and pathological characteristics and changes in serum calcitonin(CTn)and carcinoembryonic antigen levels after the surgery were compared between the 2 groups.Results:The difference in the biochemical cure rate after surgery was statistically significant between patients with preoperative serum calcitonin levels<150 pg/mL and≥150 pg/mL(P<0.01).No significant differences in the biochemical cure rates and serum calcitonin levels were noted at different time points after surgery between group A and group B(P>0.05).One recurrence and metastasis were observed in each group after surgery.Conclusions:After performing different surgical methods for the primary foci of MTMC,the changes in serum calcitonin and carcinoembryonic antigen levels are similar.Especially for patients with single foci confined to the thyroid lobe without lateral cervical lymph node metastasis and with serum calcitonin levels<150 pg/mL,the unilateral thyroid lobectomy with isthmectomy can achieve the same therapeutic effect and biochemical cure rate as total thyroidectomy.

Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance?A case report

BACKGROUND In clinical work,85%-90%of malignant thyroid diseases are papillary thyroid cancer(PTC);thus,clinicians neglect other types of thyroid cancer,such as medullary thyroid carcinoma(MTC).CASE SUMMARY We report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL.There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology,but the presence of PTC and MTC was confirmed by postoperative paraffin pathology.The patient underwent total thyroidectomy and bilateral central lymph node dissection.Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.CONCLUSION The issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC.In the absence of central lymph node metastasis,it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.

Investigation of Calcitonin and Calcitonin Gene-related Peptide in 88 Cases of Medullary Thyroid Carcinoma

Objective： To investigate the changes of calcitonin （CT） and calcitonin gene-related peptide （CGRP） in patients with medullary thyroid carcinoma （MTC）. Methods： Fifty-eight cases of MTC were selected and the relationship between the CT levels and metastasis was investigated. The immunohistochemical method was used to detect the expression of CT and CGRP in the 58 samples of MTC tissues. The CT and CGRP in 30 newly diagnosed MTC inpatients were measured before operation and in the first few days after operation using a radioimmunoassy. Results： （1） The rate of residual tumor had a significant difference between the normal serum CT group one month after operation and the elevated group at the same period （P〈0.01）. （2） Immunohistochemical study revealed the positive rate of CT was about 98%, and that of the CGRP was 87.8%. （3） Part of the patients had an elevated CGRP levels while CT levels was normal. （4） The serum CT levels were decreased to a stable range one week after operation. Conclusion： CT is a useful index to evaluate the efficacy of surgical treatment. The measurement of serum CGRP is helpful in the diagnosis of MTC, especially for those whose preoperative CT levels are normal.

Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma

Objective: To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. Although the central neck dissection (CND) is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection (LND) remains controversial. Design: Retrospective study. Methods and Main Outcome Measures: Pathological analysis of systematic ipsilateral central neck dissection (CND) and LND performed with total thyroidectomy in differentiated thyroid carcinoma was retrospectively reviewed according to “side” and to “patient”. Results: A total of 56 sides (46 patients) were suitable for analysis. Analysis by “side” revealed that CND and LND dissection samples were both negative in 15 cases, both positive in 32, CND was positive and LND was negative for 8 cases and CND was negative and LND was positive in 1 case. The combined presence of positive LND and positive CND was therefore observed in 32/40 “sides” and 26/46 “patients”. Analysis by “side” of the impact of the treatment decision to perform ipsilateral LND only in patients with positive CND and vice versa demonstrated a sensitivity, specificity, and accuracy of 97%, 65%, and 84%, respectively. Conclusions: In most cases, the presence of positive LND was associated with positive ipsilateral CND. The very low prevalence of positive LND in patients with negative CND may justify LND as a second step procedure only in patients with positive CND, except in the case of documented lateral neck metastasis.

Clinical and Sonographic Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma（PTC） between cervical lymph node metastatic（CLNM） and nonmetastatic groups.Clinical data of PTC patients（414 patients with 624 malignant nodules） who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old（ranging from 18 to 77 years）.Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569（1.502,4.393）,P〈0.001）] were as follows：the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio（DR） pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone（TSH） levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.

Is new American Thyroid Association risk classification for hereditary medullary thyroid carcinoma applicable to Chinese patients? A single-center study

Objective: The American Thyroid Association (ATA) proposed a new risk classification for hereditary medullary thyroid carcinoma (MTC) in 2015. This study aimed to assess whether the new guidelines are suitable for the Chinese population, and reported our experience on prophylactic thyroidectomy. Methods: A total of 73 patients from 22 families were screened as rearranged during transfection (RET) mutation carriers from 2010 to 2016 in Cancer Hospital, Chinese Academy of Medical Science; the medical history for each patient was collected. Based on the initial treatment, we identified the risk factors for poor prognosis by univariate and multivariate logistic regression. Then, 4 RET mutation carriers were enrolled for prophylactic thyroidectomy, and their pathological data and follow-up outcomes were recorded. Results: In univariate and multivariate logistic regression analyses, age at initial surgery and risk classification were significant risk factors for stage III/IV hereditary MTC at initial diagnosis. The likelihood was increased by 11.6% per year of age at initial surgery [95% confidence interval (95% CI), 1.040-1.198; P=0.002). It was 7.888 times more likely to have III/IV stage disease for ATA highest risk patients, compared to ATA moderate risk individuals (95% CI, 1.607-38.717; P=0.003). Postoperative pathological results showed all 4 multiple endocrine neoplasia type 2A (MEN2A) patients had C-cell hyperplasia (CCH); multifocal malignancies were detected in 3 of them. All 4 patients were cured biochemically, and none developed permanent hypoparathyroidism. Conclusions: In Chinese individuals, hereditary MTC aggressiveness is in line with the new ATA risk classification. Germline RET gene mutation carriers should undergo prophylactic thyroidectomy according to basal serum calcitonin levels.

Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma

Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia(paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome(ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma(MTC).

Active surveillance in low risk papillary thyroid carcinoma

In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.

Skull metastasis revealing a papillary thyroid carcinoma

Although thyroid carcinoma is a relatively common form of malignancy,metastatic spread to the skull is rare.Here,we report a case of papillary thyroid carcinoma with frontal and parietal metastasis.A 61-year-old Chinese woman presented with a one year history of a growing mass on the center of the frontal and parietal bone,initially thought to be meningioma.Biopsy of the skull base mass after intracalvarium excision,indicated a tumor of thyroid origin.One month later the patient underwent a total thyroidectomy.Pathological examination confirmed a diagnosis of papillary thyroid carcinoma with frontal and parietal bone metastasis.Based on this experience,the key to successful management of the skull metastasis of thyroid carcinoma is prompt diagnosis and appropriate treatment.Skull metastasis should be considered at the outset of the clinical course of papillary thyroid cancer.To facilitate this,patients should be meticulously investigated by a multidisciplinary team to improve quality of life.

Photoacoustic detection of follicular thyroid carcinoma using targeted Nano-Au-Tripods

Follicular thyroid carcinoma(FTC)is the second most common form of thyroid malignancy,and it is associated with more aggressive growth and worse long-term survival outcomes relative to papillary thyroid carcinoma(PTC).Reliable approaches to preoperative FTC detection,however,remain to be established.Herein,a targeted Affibody-Au-Tripod nanoprobe was developed and successfully utilized to facilitate the targeted photoacoustic imaging(PAI)of epidermal growth factor receptor(EGFR)-positive cells and tumors.These Affibody-Au-Tripods were found to be highly sensitive and specific for cells expressing EGFR when used as a PA contrast agent in vitro,and studies conducted in an FTC-133 subcutaneous tumor model system in mice further revealed that these Affibody-Au-Tripods were able to specifically target these EGFR-expressing tumors while providing a strong photoacoustic signal in vivo.Importantly,these nanoprobes exhibited negligible cytotoxicity and robust chemical and physical stability,making Affibody-Au-Tripods promising candidates for targeted PAI-based FTC diagnosis.In addition,these nanoprobes have the potential to facilitate the individualized treatment of patients harboring EGFRpositive tumors.

Combined targeted therapy and immunotherapy in anaplastic thyroid carcinoma with distant metastasis: A case report

BACKGROUND Anaplastic thyroid carcinoma(ATC),also called undifferentiated thyroid cancer,is the least common but most aggressive and deadly thyroid gland malignancy of all thyroid cancers[1].It has poor prognosis,and is the leading cause of death from malignant thyroid tumors.The one-year survival rate is 20%,with a median overall survival(OS)of only 5 mo[2].The aim of this report is to provide our experience in the diagnosis and treatment of ATC.CASE SUMMARY A patient with a thyroid mass underwent surgical treatment after developing symptoms of hoarseness.The resected tumor was pathologically diagnosed as ATC.Imaging examination revealed organ and lymph node metastasis.After multiple cycles of chemotherapy and local radiotherapy,the metastases were not relieved and gradually increased in size and new metastases appeared.The patient immediately received immunotherapy combined with targeted therapy.During treatment,immune-related adverse reactions occurred,which were improved after symptomatic treatment,and tolerated by the patient.The OS of the patient was more than 30 mo after immunotherapy combined with targeted therapy.CONCLUSION For metastatic ATC,surgical treatment,radiotherapy and chemotherapy have no significant effect on remission of the disease.However,immunotherapy has made a breakthrough in the treatment of ATC。

Value of thyroglobulin combined with ultrasound-guided fine-needle aspiration cytology for diagnosis of lymph node metastasis of thyroid carcinoma

BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.

Significance of VEGF and NF-κB Expression in Thyroid Carcinoma

OBJECTIVE To investigate the significance of vascular endothelial growth factor (VEGF) and nuclear factor-kappaB (NF-κB) expression in thyroid carcinoma. METHODS The expression of NF-κB and VEGF was determined by im- munohistochemistry in formalin-fixed and paraffin-embedded specimens obtained from 10 normal thyroid tissues (NT), 12 cases of thyroid adeno- ma (TA) and 68 cases of thyroid carcinoma (TC).Differences in expres- sion between NT, TA and TC were statistically analyzed. In addition, in cases of TC, the relationship of NF-κB and VEGF expression with various clinicopathological factors, including histological typing, clinical staging and lymph node metastasis, as well as the correlation between N F - κ B and VEGF expression was examined. RESULTS In contrast to the negative immunoreactivity for VEGF in NT, there was a significantly higher positive incidence (PI) in TA (41.7%, P= 0.040) and TC (75.0%, P<0.001), and a significant difference between TA and TC (P=0.036). Immunoreactivity for NF-κB in NT was negative and significantly higher in TC (63.2%, P<0.001),but not in TA (16.7%, P= 0.481). However the PI difference between TA and TC (P=0.003) was significant. Between the histological types of TC, a significantly higher PI was found in undifferentiated thyroid carcinoma (UTC),namely,100% for VEGF and 90.0% for NF-κB. We also found significant positive relation- ships of VEGF and N F - κ B expression with the clinical stage and lymph node metastasis. Furthermore, a significant positive correlation between VEGF and NF-κB expression in TC was observed. CONCLUSION Our data showed that the expression of VEGF and NF- ΚB/P65 was greater in TC and UTC, and documented their significant positive correlations with the clinical stage and lymph node metastasis in TC. In addition there was a significant positive relationship between their expression, suggesting that they have important roles in TC and that they may be potential targets for gene therapy in TC patients.

The expression and significance of hTERT and P53 in thyroid carcinoma

Objective To determine the expression of human telomerase reverse transcriptase (hTERT) and P53 in thyroid carcinoma and its relationship with development and prognosis of the carcinoma. Methods Totally 90 cases of thyroid specimens (60 thyroid carcinomas,10 thyroid adenomas,10 goitres and 10 normal thyroid tissues) were studied by SP immunohistochemical method. Results Positive immunoreactivity of hTERT and P53 was higher in thyroid carcinoma (P<0.05). The positive rates of hTERT and P53 were higher in undifferentiated carcinomas,carcinomas with lymph nodes metastasis or at stage Ⅲ+Ⅳ than in well-differentiated carcinomas,carcinomas without lymph nodes metastasis or at stage Ⅰ+Ⅱ (P<0.05). The expression of hTERT was significantly related with that of P53 (P<0.05). Conclusion Over-expressed hTERT and P53 may be related to the carcinogenesis and progression of thyroid carcinoma and hTERT expression is related to P53 protein. Examination of expression of hTERT and P53 proteins may be helpful to judge the thyroid cancer’s behavior and prognosis.

THE EXPRESSION AND SIGNIFICANCE OF P53 AND P21(WAF1/CIP1) IN THYROID CARCINOMA

Objective To determine the expression of P53 and P21 (WAF1/CIP1) in thyroid carcinomas and its relationship with development and prognosis of the carcinoma. Methods 90 cases of thyroid tissues (60 thyroid carcinomas, 10 thyroid adenomas, 10 goitres and 10 normal thyroid tissues) were studied by SP immunohistochemical method. Results Positive immunoreactivity of P53 and P21(WAF1/CIP1) was found only in thyroid carcinomas. The positive rate of the P53 and P21 is 53.3% and 41.7% respectively. The positive-staining rates of P53 were higher in cases of undifferentiated carcinomas, positive metastasis lymph nodes or in stage Ⅲ, Ⅳ than those in the cases of well-differentiated, no metastasis lymph nodes, or in stage Ⅰ,Ⅱ. In addition, the positive-staining of P21(WAF1/CIP1) were lower in cases of undifferentiated carcinomas, positive metastasis lymph nodes or stage Ⅲ, Ⅳ than that in the cases of well-differentiated, no metastasis lymph nodes or in stage Ⅰ,Ⅱ. The P21 (WAF1/CIP1) expression rate in the P53 positive group was lower than that in the P53 negative group (P<0.05). Conclusion The expression of P21(WAF1/CIP1) protein in thyroid cancer is related to P53-depend pathway and P53-independent pathway, mainly the P53-depend pathway. Examination of expression of P53 and P21 (WAF1/ CIP1) proteins may be helpful to judge the thyroid cancer's behavior and prognosis.

THE UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN THYROID CARCINOMA

Objective: To investigate the feasibility and advantages of the unilateral big hockey stick incision in thyroid carcinoma. Method: Neck dissection using the unilateral big hockey stick incision was performed on 23 patients with thyroid carcinoma. Results: The big hockey stick incision results in a cosmetic scar which is barely visible and easily covered by hair or clothing, while it provides sufficient exposure of the operation field. A small area of marginal necrosis is occasionally seen at the apex of the skin flap due to preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

Recurrent medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation:A case report

BACKGROUND Treatment for neck lymph node metastases after adequate initial surgery in medullary thyroid carcinoma(MTC)has been controversial.Ultrasound(US)-guided radiofrequency ablation(RFA)has been widely used in recurrent welldifferentiated thyroid carcinoma.Here,we report for the first time the use of RFA in a patient with recurrent MTC.CASE SUMMARY We report the case of a 56-year-old woman with cervical lymph node metastases of MTC.Four years previously,she had undergone a total thyroidectomy and neck lymph node dissection.A neck US revealed many enlarged nodes during the follow-up period.Moreover,the serum calcitonin jumped to 198.17 pg/mL,which strongly indicated the recurrence of MTC.Subsequently,two metastatic lymph nodes were confirmed by US-guided fine-needle aspiration-cytology and fineneedle aspiration-calcitonin,and then the patient was treated with RFA.Four months later,the neck US and a contrast-enhanced US showed obvious shrinkage in the ablation zones,and the serum calcitonin dropped to 11.80 pg/mL.CONCLUSION This case suggests that RFA may be an effective and safe treatment for local recurrent MTC.

Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature

BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,ef
cient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.