A 28-year-old man is referred with a germline RET mutation (C634F in exon 11) identified on screening. He has no clinical symptoms and a normal neck ultrasound. According to current ATA risk stratification, what is the recommended timing of prophylactic thyroidectomy?
- A Immediate thyroidectomy is indicated regardless of age ✓
- B Thyroidectomy before age 5 years (ATA Highest Risk category)
- C Annual calcitonin surveillance; thyroidectomy only when calcitonin rises above normal
- D Thyroidectomy within the first 6 months of life
Explanation
RET codon 634 mutations (exon 11) are classified as ATA High Risk (category C) by the American Thyroid Association. For this category, prophylactic thyroidectomy should be considered before age 5 years; however, for the Highest Risk category (codon 918 mutation in MEN2B), thyroidectomy is recommended within the first 6 months of life. At age 28 with no symptoms, this patient should have already had thyroidectomy but currently still requires total thyroidectomy given the mutation. The phrasing 'immediate' is most appropriate for an adult with a known high-risk mutation who has not yet been treated — surveillance alone is not adequate management.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.