A 35-year-old patient with MEN2A syndrome and serum calcitonin 420 pg/mL undergoes total thyroidectomy for medullary thyroid carcinoma (MTC). Intraoperatively, which specific regional lymphadenectomy should be performed as standard of care?

• A Ipsilateral modified radical neck dissection only
• B Central compartment dissection alone is adequate for all MTC cases
• C No lymphadenectomy; radioiodine will address residual disease
• D Central compartment dissection (level VI) plus bilateral lateral neck dissection for elevated calcitonin ✓

Explanation

For MTC with calcitonin >400 pg/mL (some guidelines >200 pg/mL), prophylactic bilateral central neck dissection (level VI) plus bilateral lateral neck dissection (levels II–V) is recommended because of high likelihood of lateral nodal metastasis. Central compartment dissection alone suffices only for very low calcitonin (some guidelines <20 pg/mL) and small primary tumors. Radioiodine has no role in MTC as follicular cells are not involved. MTC staging and operative extent are calcitonin-guided per ATA guidelines.

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

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Written and medically reviewed by the StethoPrep medical team.