Management of recurrent papillary thyroid carcinoma: diagnosis, surveillance, and treatment strategies

Papillary thyroid carcinoma (PTC) accounts for over 85% of all thyroid malignancies and generally has a favorable prognosis, with 10-year overall survival exceeding 90%. Nonetheless, locoregional recurrence develops in 5%-30% of patients within the first decade following initial treatment, and cervical lymph node metastasis represents the predominant recurrence pattern. Accurate detection relies on serial neck ultrasonography, serum thyroglobulin measurement, fine-needle aspiration cytology with thyroglobulin washout analysis, and selective use of cross-sectional imaging or 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Management should be individualized through a multidisciplinary framework, ranging from active surveillance for small, indolent nodal disease to compartment-oriented surgical reoperation, radioactive iodine therapy, external beam radiation, percutaneous ablation, and systemic targeted therapy for progressive radioactive iodine-refractory disease. This review synthesizes current evidence and guideline recommendations for recurrent PTC. Particular emphasis is placed on the 2015 and 2025 American Thyroid Association guidelines and the National Comprehensive Cancer Network Version 1.2025 guidelines to provide a structured, clinically oriented approach.