A 58-year-old man with recurrent laryngeal nerve palsy on the left side is found to have a 4 cm thyroid mass. Fine-needle aspiration cytology shows Bethesda category VI (malignant) consistent with anaplastic carcinoma. The most appropriate initial management is:
- A Total thyroidectomy with central neck dissection
- B Radioactive iodine (I-131) therapy
- C BRAF V600E testing and targeted therapy with dabrafenib + trametinib if positive ✓
- D External beam radiotherapy combined with chemotherapy (doxorubicin-based)
Correct answer: C. BRAF V600E testing and targeted therapy with dabrafenib + trametinib if positive
Explanation
Anaplastic thyroid carcinoma (ATC) is staged uniformly as Stage IV and carries a median survival of 5 months. BRAF V600E mutation is present in approximately 40–50% of ATC cases. FDA approval of dabrafenib (BRAF inhibitor) + trametinib (MEK inhibitor) for BRAF V600E-mutant ATC has changed the treatment paradigm — molecular testing should be performed urgently. Surgery is rarely curative and is not indicated with RLN palsy suggesting local invasion.
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.