A patient with MEN2A syndrome (RET mutation codon 634) has serum calcitonin of 450 pg/mL and a 1.5 cm thyroid nodule. Preoperative imaging shows no cervical lymphadenopathy. The most appropriate surgical management is:

• A Total thyroidectomy alone
• B Hemithyroidectomy with central neck dissection
• C Total thyroidectomy with bilateral central and lateral neck dissection
• D Total thyroidectomy with central neck dissection ✓

Explanation

In medullary thyroid carcinoma (MTC) with elevated calcitonin >200 pg/mL, central neck dissection (level VI) is recommended alongside total thyroidectomy even when preoperative imaging shows no lymphadenopathy, because calcitonin >200 pg/mL predicts high probability of central node micrometastases. Lateral neck dissection is added only when imaging or clinical evidence of lateral node involvement exists. With codon 634 RET mutations (highest-risk MEN2A), total thyroidectomy is the standard oncologic procedure.

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

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Written and medically reviewed by the StethoPrep medical team.