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Background: with the requirement of aggressive follow-up in patients with biochemically incomplete response in patients of papillary ca. thyroid with neck node, a predictor for clinical response would be of great help for better treatment and follow-up planning. Aim: To determine the utility of lymph-node ratio (central and lateral) as predictors for clinical response post total thyroidectomy and neck dissection. Materials and methods: 51 patients of papillary carcinoma thyroid with neck node were treated with surgery and RAI as per ATA guidelines and were analyzed for a median of 3 years. (Retrospective cohort analysis). Results: We did response evaluation, correlated clinical response with lymph-node ratios. We found a statistically significant relationship of lymph-node ratio with around a sensitivity and specificity of approximately 90% in predicting the biochemically incomplete response. Conclusion: we conclude that lateral and central compartment ratios can be used in predicting the occurrence of biochemically incomplete response. Highlights for review: New idea of evaluating sensitivity and specificity of lymph node ratio in predicting biochemical response. Well conducted study. ROC analysis. Median follow up of 3.1 years with follow ups every 3months. Lay summary: In patients with papillary carcinoma thyroid with neck node metastasis, the ratio of lymph-nodes harvested to the number of nodes that are actually positive for the cancer can be used successfully in predicting the clinical outcome in these patients post total thyroidectomy and neck dissection. This ratio as an indicator of clinical response can be used to predict those patients who might end up in the category of biochemically incomplete response. So, that they can be treated aggressively with adjuvant RAI and followed-up aggressively. [ABSTRACT FROM AUTHOR]