A 9-year-old asymptomatic boy whose mother had medullary thyroid carcinoma is found to carry a germline RET proto-oncogene mutation. Basal calcitonin is elevated. What is the recommended surgical management?
- A Total thyroidectomy with central compartment lymph node dissection ✓
- B Annual calcitonin surveillance with surgery once nodules appear
- C Hemithyroidectomy followed by radioactive iodine ablation
- D Total thyroidectomy with lateral neck dissection only if calcitonin exceeds 500 pg/mL
Correct answer: A. Total thyroidectomy with central compartment lymph node dissection
Explanation
Medullary thyroid carcinoma arises from parafollicular C cells, secretes calcitonin, and is not radioiodine avid, which eliminates options involving radioactive iodine. In a germline RET carrier, prophylactic total thyroidectomy with central lymph node dissection is performed in childhood because C-cell hyperplasia progresses to malignancy early, and waiting for nodules risks metastatic spread. Calcitonin is the tumor marker used for follow-up, not a trigger to defer surgery.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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