A 35-year-old man is found to have a 2.2 cm papillary thyroid microcarcinoma (PTMC) with bilateral multifocal disease. BRAF V600E mutation is confirmed on molecular testing. According to current ATA risk stratification, this patient is classified as:
- A Low risk — surveillance without surgery is recommended
- B High risk — total thyroidectomy with prophylactic central neck dissection and RAI ablation
- C Intermediate risk — total thyroidectomy recommended with selective lymph node dissection based on ultrasound findings ✓
- D Very low risk — active surveillance acceptable without any intervention
Correct answer: C. Intermediate risk — total thyroidectomy recommended with selective lymph node dissection based on ultrasound findings
Explanation
ATA intermediate-risk differentiated thyroid cancer includes unifocal PTC with vascular invasion, multifocal disease, clinically N1a (central neck nodal metastases), aggressive histology, or BRAF V600E mutation in certain contexts. Bilateral multifocal PTMC warrants total thyroidectomy (not just lobectomy). The presence of BRAF V600E is associated with higher recurrence but does not by itself mandate prophylactic central neck dissection unless ultrasound-detected nodal disease is present. RAI ablation is individualized, not universally required at intermediate risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.