A patient with MEN2A is found to have a 4 mm medullary thyroid carcinoma (MTC) on prophylactic thyroidectomy. The pentagastrin-stimulated calcitonin was mildly elevated. Intraoperative examination reveals no gross nodal disease. What is the minimum surgical procedure required according to current guidelines?

• A Hemithyroidectomy with central compartment dissection
• B Total thyroidectomy alone without nodal dissection
• C Total thyroidectomy with central compartment lymph node dissection ✓
• D Near-total thyroidectomy with ipsilateral central neck dissection

Explanation

For hereditary MTC (MEN2A), ATA guidelines recommend total thyroidectomy. Central compartment (level VI) lymph node dissection is also recommended when the primary tumor is >5 mm or when basal/stimulated calcitonin is elevated, as nodal involvement risk increases with these factors. Even for very small tumors, central neck dissection is performed given the high rate of occult nodal metastasis in MTC (which does not concentrate iodine and has no RAI adjunct). Lateral neck dissection is added only if central or lateral nodes are clinically or sonographically involved.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.