Purpose: Papillary thyroid microcarcinoma (PTMC) is generally associated with an excellent prognosis. Despite this, lymph node metastases (LNM) are not uncommon which may influence decision making and clinical management. This study evaluates the rates of LNM in PTMC at our centre and explores clinicopathological variables associated with the presence of LNM. Methods: One hundred twenty-one cases of PTMC that were managed at a single centre from 2013 to 2024 were retrospectively analysed. Data on clinicopathological variables, including age, gender, multifocality, tumour size, extra-thyroidal extension and lymph node status, were collected. Lymph node dissection outcomes were categorized by central and lateral lymph nodes. Results: One hundred twenty-one PTMC patients were included in this study. Lymph Node dissection was performed for 57 patients and of those, 21 (37%) had LNM. Central LNM were found in 17/57 (30%) patients undergoing central lymph node dissection (CLND) and lateral LNM were identified in 10/11 (91%) patients undergoing lateral lymph node dissection.Multifocality (77.27% vs. 48.57%, P<0.05) and microscopic extrathyroidal extension (40.91% vs. 2.86%, P<0.0005) were associated with LNM. Patients with PTMC had lower rates of gross extrathyroidal extension (0% vs. 9.16%, P<0.001) and positive surgical margins (18.18% vs. 27.89%, P<0.05) compared to patients with macrocarcinoma. Conclusion LNM are not uncommon in PTMC, despite its indolent nature. Multifocality and extrathyroidal extension were found to be associated with LNM in PTMC patients. These findings suggest that prophylactic CLND should be considered in PTMC when these risk factors are present. Further studies are needed to refine PTMC management strategies.

The RET oncogene plays an important role in multiple endocrine neoplasia (MEN) type 2B and the development of medullary thyroid cancer. Highest risk amongst these RET codon mutations is M918T. Most cases of MEN type 2B are detected de novo later in childhood, however there remain instances of parental inheritance. When parenteral inheritance of a M918T mutation is confirmed after birth current guidelines recommend a prophylactic thyroidectomy in infancy. We report a case of twin boys born to a 31-yearold female with known MEN2B RET codon M918T mutation. Both boys had confirmatory testing for the M918T mutation after birth. After pre-operative investigations revealed sonographically normal thyroids, no cervical lymphadenopathy and normal calcitonin levels they both underwent prophylactic thyroidectomy at 7 months corrected gestational age. Thyroidectomies in infancy offer unique challenges including translucent parathyroid glands and airways too narrow to accommodate a standard Neural Integrity Monitor (NIM) endotracheal tube. We describe our surgical technique for an infant total thyroidectomy and fashioning of a novel NIM tube to allow for recurrent laryngeal nerve (RLN) monitoring to minimise complications in these very young patients. Both infants made a complete recovery without any significant complication. Histopathology revealed evidence of focal C Cell hyperplasia, but no malignancy in either thyroid gland. Our experience with these 2 cases highlights the importance of an experienced multidisciplinary team in infant thyroidectomies and outlines a novel technique to allow for RLN monitoring intraoperatively.