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The treatment of PTC is a total thyroidectomy with or without central lymphadenectomy followed or not followed by RAI therapy depending on the histotype and the presence of mutations . Lymph node recurrence can occur in about 1–2% of patients after surgical and RAI therapy . It can be treated with surgery or with additional RAI therapy, even if reoperations are burdened by a very high rate of major complications (25% of cases of vocal cord palsy) and metabolic radiotherapy is burdened by a very high failure rate when repeated. In fact, various studies have shown that neoplastic cells subjected to repeated RAI therapies lose the ability to pick up radioactive iodine. Ultrasound-guided mini-interventional procedures are an effective and safe alternative . The minimally invasive ultrasound-guided procedures have been developed and validated. They can be performed repeatedly without an increased complication rate, without hospitalization and general anesthesia; all characteristics well accepted by patients. Ultrasound guided. Laser Ablation (LA) Tecnique appears to be the safest and the most effective technique.currences. Therefore, LA can be considered an alternative treatment for patients who are unsuitable.We retrospectively enrolled 10 patients (5 males and 5 females) treated with a single LA session for a single lymph node recurrence. All patients had a diagnosis of classic variant PTC that had been previously treated with a total thyroidectomy and RAI.The ultrasound examination was conducted with a 7.5–12 MHz linear probe (MyLab™ ClassC and MyLab™ 9 Platform, Esaote Biomedica, Genova, Italy). The basal volume of the lymph node lesion was calculated using the software. Vascularity was studied by Color Doppler (CD) examination and slow flow analysis.We used a continuous wave multi-source laser system with a length of 1064 nm (EchoLaser ModiLite TM , Elesta SpA, Calenzano, Italy).The patients underwent a single LA session. The procedure was performed by placing the patients in a supine position with a moderate hyperextension of the neck. We performed a pericapsular local anesthesia with 2% Lidocaine. The applicators used were 21 Gauche (G) needles. We used an output power of 3 Watts in nine cases and a power of 4 Watts in only one case, due to the lymph node’s volume. The fibers used were quartz optical fibers with a flat tip and a diameter of 300 microns. The applicators were inserted into the target lesion through guides applied to the probe with different angles of incidence depending on the pre-treatment planning. All patients were treated with suppressive therapy with L-thyroxine. During the oncological follow-up, all patients had an increase in the serum Tg value greater than 20 μ g/L. The increase serum Tg was followed by an ultrasound of the neck which revealed the presence of disease. There were seven metastatic lymph nodes at level IV and three at level Vb with a baseline volume of 1.82 mL . In all cases, a FNAC of the suspected lesion was performed with a Tg assay on the eluate.Our series of 10 patients showed that a normalization of serum thyroglobulin levels, the absence of neoplastic cells in the control FNC and the absence of Tg in the eluate were recorded 6 months after the ablative treatment.