The role of prophylactic parathyroidectomy during thyroidectomy for MTC in patients with MEN2A syndrome

Aim: To define the role of prophylactic parathyroidectomy in the surgical treatment of medullary thyroid carcinoma (MTC) in multiple endocrine neoplasia type IIa (MEN2A) syndrome through a literature review. Materials and methods: The database of PubMed was searched using the terms “parathyroidectomy” and “medullary” in the fields “Title” and “Abstract”, as well as the Google Scholar database. Articles without references to parathyroid management strategies were mainly excluded. Results: Fourteen articles were reviewed as relevant to this study regarding recommendations for the management of parathyroids during prophylactic thyroidectomy in patients with MTC in MEN2A syndrome. Three of them had the same or similar purpose to our work, and the most recent literature review did not clearly support either one of the two management strategies. References to parathyroid management were found in the rest of the articles, but their purpose was not to determine the appropriate management strategy. The majority of the authors support the preservation of macroscopically normal parathyroid glands, while one study favored routine total parathyroidectomy and autografting. Conclusions: Although there does not seem to be a gold standard, the strategy of preserving macroscopically normal parathyroid glands with routine lab testing and surgical exploration for hyperparathyroidism during thyroidectomy seems to be a safe and effective strategy.