Lymph Node Ratio Independently Associated with Postoperative Thyroglobulin Levels in Papillary Thyroid Cancer

•LNR was independently associated with postoperative Tg levels.•Patients with a high LNR were more likely to have biochemical incomplete response.•The mean LNR in the central neck was 0.22.•The mean LNR in the lateral neck was 0.06.•Twenty patients (16.9%) had postablative uTg ≥ 1 ng/mL. To investigate the impact of the lymph node ratio (LNR) on postoperative thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). This was a retrospective, cohort study. The association between clinicopathological variables and postoperative unstimulated Tg (uTg) levels, preablative-stimulated Tg (sTg) levels, and postablative unstimulated Tg levels was analysed. A total of 300 patients with PTC were identified. Multivariate logistic analysis showed that M classification (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.62–3.34), and postoperative thyroid-stimulating hormone levels (OR, 1.01; 95% CI, 1.01–1.02) were independently associated with postoperative uTg levels. One hundred and sixteen patients underwent radioactive iodine (RAI) therapy. Multivariate analysis showed that LNR in the central neck (OR, 1.24; 95% CI, 1.02–1.51), LNR in the lateral neck (OR, 1.73; 95% CI, 1.09–2.77), RAI dose (OR, 1.43; 95% CI, 1.21–1.69), and M classification (OR, 1.79; 95% CI, 1.22–2.61) were independently associated with preablative sTg levels. Tumour size (OR, 1.01; 95% CI, 1.00–1.01), LNR in the central neck (OR, 1.28; 95% CI, 1.08–1.51), LNR in the lateral neck (OR, 1.66; 95% CI, 1.10–2.49), RAI dose (OR, 1.54; 95% CI, 1.34–1.79), and M classification (OR, 1.56; 95% CI, 1.12–2.19) were also independently associated with postablative uTg levels. LNR was independently associated with postoperative Tg levels in patients with PTC. Patients with high LNR were more likely to have incomplete biochemical responses after surgery.