In patients with Multiple endocrine neoplasia type 2B (MEN2B) presenting with medullary thyroid carcinoma (MTC) — whether hereditary or sporadic — and no evidence of neck lymph node metastases on ultrasound examination and no distant metastases, an evidence-based surgical intervention is the recommended first-line approach.
The standard management centres on a thyroid-directed surgical procedure that also addresses regional lymph node involvement. The full protocol defines the precise operative scope, the criteria that guide the extent of dissection, and the conditions under which it applies.
The primary measure of treatment success is achievement of undetectable postoperative serum calcitonin levels, reflecting complete removal of the relevant thyroid tissue.
DOI: 10.1089/thy.2014.0335
Total thyroidectomy and dissection of cervical lymph node compartments, depending on serum Ctn levels and US findings, is standard treatment for patients with sporadic or hereditary MTC.
Patients with MTC and no evidence of neck lymph node metastases by US examination and no evidence of distant metastases should have a total thyroidectomy and dissection of the lymph nodes in the central compartment (level VI).
These data indicate that postoperative serum Ctn levels should be undetectable following complete removal of thyroid tissue.
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