The lady is having one child of three years age and she wants to have one more kid..

First, search for an ectopic primary. A PET scan may be useful. In the presence of a normal functioning gland, a diagnostic radio Iodine scan may be insufficient . The thyroid gland must be sacrificed anyways to facilitate post operative radio iodine therapy.

My feeling would be to go for a total thyroidectomy with appropriate neck dissection and excision of the ectopic thyroid primary if accessible.

Thank you Harindra Narayana for your response.

What should be done if the thyroid does not show up the primary? Has anyone seen an ectopic thyroid rest with PTC presenting with a node

I think the need for aggressive treatment is not completely justified. The question about the origin of these metastasis of unknown primary is far from being solved.

I agree about the need for intensive scanning (PET, CT...) but if no primary is found there is enough evidence in the literature to support a strict follow-up, given the low aggressivity of these tumors and the favorable progostic factors (age

One more from our own data.

Article Incidence and Significance of Clinically Unsuspected Thyroid...

One more article from our own data

Article Incidence and Significance of Clinically Unsuspected Thyroid...

Thank you Jacinto for your response

I believe it depends context. Most of these patients will need total thyroidectomy + CND + LND to deal with their metastatic thyroid cancer. However, this issue occasionally arises in a patient who has undergone neck dissection for SCC. These patients are at much higher risk of death from SCC than thyroid cancer. Many will also have history of tracheostomy and RT which will significantly increase operative difficulty, and may have chronic laryngeal odema such that a VCP may lead to stridor. Therefore I would avoid thyroidectomy in SCC patients unless there is an FNA-proven cancer within the thyroid gland.

First, thanks for your good question on a still debatable subject.

Once you have discovered a metastatic papillary cancer that means a primary focus (or+) of papillary carcinoma awaits for your discovery in thyroid tissue. A normal USG is only a normal USG that doesn't necessarily reflect the whole pathologic picture. In my practice I would proceed with a frozen controlled total thyroidectomy and limited neck exploration. Otherwise in the future we can see this patient as a pregnant woman who admitted to the clinic with a thyroid mass (and with cervical nodes, may be..). I think this is a much more complex situation to solve.