A 40-year-old man with MEN2A undergoes prophylactic thyroidectomy. His RET mutation is identified at codon 634 (C634F). At what age should prophylactic thyroidectomy have been recommended according to current ATA guidelines?
- A Within the first 6 months of life
- B By age 5 years ✓
- C Before age 5 years but after age 1 year
- D At diagnosis, regardless of age, if calcitonin is elevated
Correct answer: B. By age 5 years
Explanation
RET codon 634 mutations are classified as American Thyroid Association high-risk (Category C). ATA guidelines recommend prophylactic thyroidectomy by age 5 years for high-risk mutations, provided serum calcitonin is normal and family history does not reveal very early medullary thyroid carcinoma. The highest-risk mutations (e.g., codon 918, M918T) in MEN2B require prophylactic thyroidectomy within the first 6 months of life.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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