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.
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. Start with central node dissection unless there's clear lateral disease.
d) Right hemithyroidectomy: Inadequate for managing MTC. Since MTC can be bilateral and multifocal, a total thyroidectomy is the standard of care.