Extremely careful therapeutic MND is required for N1b patients with age >55 years or node metastasis >3 cm because of the likelihood of recurrence in previously dissected compartments. Bilateral MND (therapeutic for ipsilateral side and prophylactic for contralateral side) may be a therapy option for N1b PTC >4 cm and having extrathyroid extension.
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Ito et al. (2011) studied this question.
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