A patient with MEN 2A syndrome is found to have a serum calcitonin of 450 pg/mL (normal <10) and a 2.5 cm right thyroid nodule on ultrasound. RET codon 634 mutation is confirmed. Which operation is indicated?
- A Total thyroidectomy with bilateral central neck dissection ✓
- B Right hemithyroidectomy with ipsilateral central neck dissection
- C Total thyroidectomy alone
- D Right hemithyroidectomy alone, with contralateral completion if margins positive
Correct answer: A. Total thyroidectomy with bilateral central neck dissection
Explanation
MEN 2A with RET codon 634 mutation carries a high risk of bilateral and multifocal medullary thyroid carcinoma. With calcitonin >200 pg/mL or a clinically evident tumour >1 cm, bilateral central (level VI) compartment neck dissection is recommended alongside total thyroidectomy because microscopic nodal metastases are expected. Hemithyroidectomy is inadequate given the bilateral nature of MEN-associated MTC.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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