In patients with MEN2A-associated medullary thyroid carcinoma (MTC), the goal of the first surgical intervention is biochemical cure. When postoperative serum calcitonin fails to normalize, a structured next-line protocol applies — determined by the extent of residual or metastatic neck disease.
The initial procedure — total thyroidectomy with central compartment (level VI) dissection in patients without ultrasound evidence of lymph node metastases or distant spread — did not result in normalization of basal serum calcitonin to a normal or undetectable level (< 10 pg/mL) postoperatively. Biochemical cure was not achieved.
For patients whose MTC remains confined to the neck and cervical lymph nodes, the next step involves more extensive surgical management of the neck — addressing both central and lateral neck compartments. The full protocol specifies the exact compartments, patient selection criteria, and sequencing.
Complete regimen available via the structured protocol below.DOI: 10.1089/thy.2014.0335
Patients with MTC confined to the neck and cervical lymph nodes should have a total thyroidectomy, dissection of the central lymph node compartment (level VI), and dissection of the involved lateral neck compartments (levels II–V).
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