A 60-year-old woman presents with a 4 cm right thyroid nodule. FNAC shows Hurthle cell predominance with a microfollicular pattern and is reported as Bethesda Category IV. Which statement best guides surgical management?

• A Lobectomy is sufficient as the risk of malignancy is less than 5%
• B Total thyroidectomy is always required regardless of lobectomy findings
• C Diagnostic lobectomy is indicated, with completion thyroidectomy if malignancy is confirmed ✓
• D Radioactive iodine ablation is the first-line treatment

Explanation

Bethesda Category IV (Follicular Neoplasm/Suspicious for Follicular Neoplasm) carries a 25-40% malignancy risk. Capsular and vascular invasion cannot be assessed on cytology, so diagnostic lobectomy is indicated. If histopathology confirms follicular carcinoma with adverse features, completion thyroidectomy is performed. RAI is not first-line for a solid nodule without confirmed malignancy.

Reference: Thyroid Fine-Needle Aspiration, 2nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.