Response to the Correspondence Regarding "Cutaneous Metastasis From Papillary Thyroid Carcinoma Eight Years After Initial Surgery".

We sincerely thank Dr. Sengul and colleagues for their insightful comments on our case report of skin metastasis in papillary thyroid cancer (PTC). They questioned the adequacy of local excision and suggested completion thyroidectomy to enable radioactive iodine (RAI) therapy or systemic therapy. We appreciate their perspective but explain our rationale, given the exceptional rarity of isolated cutaneous metastasis and limited evidence-based guidelines. Complete surgical excision may be appropriate for carefully selected patients with solitary cutaneous metastasis, whereas RAI or systemic therapy should be considered according to disease extent, iodine avidity, tumor biology, and patient-specific factors. We agree that TSH suppression alone does not explain the development of metastasis and that TERT promoter mutations may provide additional insight into the aggressive biological behavior of PTC. Despite the loss of thyroglobulin (Tg) expression in the metastasis, our multimodal surveillance-including ultrasonography and CT-has shown no recurrence, and we will offer functional imaging when clinical indicated. No evidence of recurrent or additional metastatic disease during follow-up, and per 2025 ATA guidelines, shared decision-making favored thyroid preservation with close follow-up. Future disease progression would prompt reconsideration of total thyroidectomy with RAI or targeted therapy.