Which feature most reliably distinguishes papillary thyroid microcarcinoma (PTMC) with low surgical risk from PTMC requiring completion thyroidectomy on active surveillance protocols?

• A Tumor size exceeding 5 mm
• B Presence of BRAF V600E mutation on molecular testing
• C Multifocality with bilateral microcarcinomas
• D Proximity to recurrent laryngeal nerve or trachea, or clinical N1 disease ✓

Explanation

The Kuma Hospital and Ito Hospital active surveillance protocols identify high-risk features in PTMC that mandate surgery rather than observation: location adjacent to the trachea or recurrent laryngeal nerve, clinical lymph node metastasis (N1), and high-grade histological features. BRAF mutation alone does not mandate completion thyroidectomy in low-risk PTMC. Multifocality and bilateral tumors are relative, not absolute, indications for surgery. Tumor size threshold for active surveillance is typically ≤1 cm, but anatomical location is the key safety criterion.

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.