The authors report the case of a 27-year-old woman with gamma probe-guided resection of a recurrent regional lymph node metastasis in papillary thyroid cancer. Reoperation is often impaired in cases with extensive scarring because of previous surgery, high-dose radioiodine therapy, and external irradiation. In this case with nodal metastasis, the high I-123 uptake allowed more rapid intraoperative detection and influenced the surgical approach. Evidence of complete removal of tumor tissue could be given intraoperatively by measuring the tumor bed, and this was confirmed by postoperative normalization of Tg levels and a negative I-131 scan. In other locations, and especially for small solitary lesions, gamma probe-guided surgery may be a promising alternative to high dose I-131 therapy.
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