A patient with MEN2A syndrome undergoes total thyroidectomy for medullary thyroid carcinoma. Intraoperatively, the parathyroid glands appear enlarged bilaterally. The appropriate surgical management of the parathyroids in this setting is:
- A Leave all parathyroid glands in situ
- B Subtotal parathyroidectomy or total parathyroidectomy with autotransplantation ✓
- C Remove the most enlarged gland only
- D Remove all four glands permanently to prevent recurrent hyperparathyroidism
Correct answer: B. Subtotal parathyroidectomy or total parathyroidectomy with autotransplantation
Explanation
MEN2A includes primary hyperparathyroidism (HPT) in up to 20–30% of cases due to multiglandular parathyroid hyperplasia. Subtotal parathyroidectomy (3.5-gland removal) or total parathyroidectomy with heterotopic autotransplantation to the non-dominant forearm is standard to achieve eucalcaemia while preserving some parathyroid function. Simple single-gland removal risks persistent HPT; total removal without autograft causes permanent hypoparathyroidism.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.