Central lymph node dissection (CLND) is controversial in patients with well differentiated thyroid cancer. Our aim in the study is to investigate the necessity of CLND in Bethesda 5 and 6 patients who underwent bilateral total thyroidectomy (BTT) and prophylactic central lymph node dissection (p-CLND).

Two-hundred and eighty patients with Bethesda 5-6 lesions who underwent BTTbetween June-2020 and September-2023 were retrospectively evaluated. Sixty-four patients were excluded from the study. Two-hundred sixteen patients who underwent BTT and p-CLND were evaluated in demographic values, pathology results and complication rates.

Among all patients 30% were Bethesda 5. Metastatic lymph nodes were detected in 127 of 168 patients. Of the 127 patients with lymph node metastases, 59 (46%) patients required additional radioactive iodine treatment solely because of lymph node metastases, regardless of other risk factors. When a total of 216 patients were evaluated, the positive lymph node rate was found to be significantly higher in male gender. When evaluated in terms of tumor size, lymph node positivity was detected in 49% of tumors with a diameter of less than 2cm. Signal loss was observed in 19 patients. Postoperative vocal cord movement was normal in all patients with type-2 signal loss. Permanent hypocalcemia was observed in 15 of 216 patients who underwent p-CLND.

Overall survival is high in well-differentiated thyroid carcinomas. Recurrence, repeated RAI treatments and surgeries do affect disease-free survival. Our treatment algorithm was changed in 46% of the patients due to p-CLND in patients with Bethesda 5 and 6.