BACKGROUND: Although lobectomy is considered acceptable as a primary surgical treatment for papillary thyroid carcinoma in properly selected patients, a standard treatment for postlobectomy lymph node recurrence has not been established. Here we compared the effectiveness of therapy with lymphadenectomy alone to that of treatment with completion thyroidectomy and lymphadenectomy followed by radioactive iodine. METHODS: This was a retrospective study of patients with papillary thyroid carcinoma who underwent surgery for lymph node recurrence in the period from January 2003 to December 2008, all of whom had previously undergone initial lobectomy with or without lymph node dissection. One-hundred and twenty-five patients were included in the primary analysis. RESULTS: Ninety-eight of these patients underwent lymphadenectomy alone (L group), and 27 received lymphadenectomy and completion thyroidectomy followed by radioactive iodine (LC&R group). The median follow-up time was 10.2 years. The overall survival, distant relapse-free survival, and lymph node relapse-free survival were not significantly different between the LC&R and L groups (P = .89, 0.58, and .22, respectively), whereas the LC&R group patients had significantly longer operation time, higher blood loss, and a higher rate of postoperative hypoparathyroidism compared with the L group (P < .001, respectively). CONCLUSION: Compared with completion thyroidectomy and lymphadenectomy followed by radioactive iodine, lymphadenectomy alone was considered an acceptable therapeutic option which decreased the surgical disadvantages but did not decrease survival for at least 10 years after recurrence surgery for PTC patients with only lymph node recurrence.