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PTC Surgical Management — RACP Adult Medicine MCQ

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ModerateEndocrinologyPTC Surgical ManagementRACP Adult Medicine

A 40-year-old man has a thyroid nodule FNA reported as Bethesda VI (malignant — consistent with papillary thyroid carcinoma). The nodule is 1.5 cm. There is no extrathyroidal extension or lymphadenopathy on ultrasound. What is the most appropriate management?

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Correct answer: D — Thyroid lobectomy without FNA

Bethesda VI (malignant) with papillary thyroid carcinoma 1-4 cm without extrathyroidal extension, lymphadenopathy, or distant metastases can be managed with thyroid lobectomy (or total thyroidectomy per patient/surgeon preference). ATA 2015 guidelines support lobectomy for low-risk PTC 1-4 cm as it has equivalent survival to total thyroidectomy but avoids lifelong full-dose levothyroxine requirement and bilateral RLN risk.

Reference: ATA – 2015 – Differentiated Thyroid Cancer; eTG Endocrine 2024