A 35-year-old woman has a 1.8 cm solitary thyroid nodule. FNAC shows Bethesda Category IV (follicular neoplasm). Molecular testing reveals a RAS point mutation. The most appropriate next step is:

• A Diagnostic hemithyroidectomy (lobectomy) ✓
• B Total thyroidectomy with central neck dissection
• C Repeat FNAC in 6 months
• D Radioactive iodine ablation therapy

Explanation

Bethesda IV nodules carry a 25–40% malignancy risk; a RAS mutation alone does not mandate total thyroidectomy upfront. Diagnostic hemithyroidectomy allows definitive histological assessment of the capsule and vascular invasion needed to classify follicular carcinoma. If final histology confirms malignancy, completion thyroidectomy is performed. Central neck dissection is not indicated for cytologically indeterminate nodules without evidence of lymph node involvement.

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.