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A 24-Year-Old Woman Has a 2

Question 277
Multiple Choice
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Multiple Choice

A 24-year-old woman has a 2.1-cm nodule in her right thyroid lobe.  She is otherwise healthy and takes no medications.  The patient has no past history of radiation exposure or family history of thyroid disease.  She does not experience pain, difficulty swallowing, or voice changes.  Physical examination is within normal limits.  Laboratory studies show normal T3, T4, and TSH levels.  An ultrasound of the thyroid gland reveals a solid nodule measuring 2.6 x 1.7 x 1.3 cm in the right lobe.  The left lobe appears to be normal in size and echotexture. Further workup of this patient confirms the diagnosis of medullary thyroid cancer.  Serum calcitonin is 300 pg/mL (normal 0-10 pg/mL).  Genetic studies show a mutation in the RET proto-oncogene.  Which of the following is the best next step in the management of this patient?

A)Measure plasma-free metanephrine
B)Refer for thyroidectomy
C)Refer to an oncologist for chemotherapy
D)Treat with external beam radiation
E)Treat with radioactive iodine

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