American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which condition is primarily treated with total thyroidectomy in patients with MEN 2B?

1. Cretinism

2. Medullary thyroid cancer

3. Hyperthyroidism

4. Thyroid goiter

The correct answer is: Medullary thyroid cancer

In patients with Multiple Endocrine Neoplasia type 2B (MEN 2B), the primary reason for performing a total thyroidectomy is the presence of medullary thyroid cancer. MEN 2B is associated with the development of tumors, including medullary thyroid carcinoma, which arises from parafollicular C cells of the thyroid that produce calcitonin. Given that medullary thyroid cancer can present at a young age and has a risk of aggressive behavior and metastasis, proactive management through surgical removal of the thyroid gland is crucial to prevent the progression of cancer. Furthermore, early total thyroidectomy has been shown to significantly improve overall survival rates in affected patients. Other conditions such as cretinism, hyperthyroidism, and thyroid goiter are typically treated with different therapeutic approaches. Cretinism is associated with congenital hypothyroidism and would not require thyroidectomy; hyperthyroidism often involves medication or ablative therapy rather than surgical intervention; and thyroid goiter, depending on the cause, might not necessitate total thyroid removal unless it is causing compressive symptoms or is suspicious for malignancy.