Q) 42 year old Male patient with 1 cm nodule in Right side of Thyroid. Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management
a) Total thyroidectomy
b) Total thyroidectomy with central node dissection
c) Total thyroidectomy with lateral and central neck dissection
Medullary thyroid carcinoma is associated with a risk of nodal involvement, even if neck nodes are not visible on ultrasound. A total thyroidectomy is recommended to remove the affected thyroid tissue, and central neck dissection is indicated to address potential lymphatic spread.
Total thyroidectomy
While a total thyroidectomy is necessary for medullary thyroid carcinoma (MTC) to remove the entire gland, it does not include the assessment and potential removal of central lymph nodes, which can harbor metastases. Given the risk of lymphatic spread with MTC, central node dissection is recommended.
c) Total thyroidectomy with lateral and central neck dissection
This option is more extensive than typically required for a 1 cm medullary carcinoma without evidence of lymph node involvement. While MTC can spread to lateral nodes, the primary recommendation is to start with central node dissection unless there are clinical signs or imaging suggesting lateral node involvement. A more conservative approach is often favored unless there's clear evidence of lateral disease.
d) Right hemithyroidectomy
A hemithyroidectomy would only remove half of the thyroid gland and is inadequate for managing MTC. Since MTC can be bilateral and has the potential for multifocality, a total thyroidectomy is the standard of care to ensure complete removal of the cancerous tissue.
