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Neck ultrasound Recommend To assess for added thyroid masses and neck lymphadenopathy Laparoscopy of liver Consider As clinically indicated if involved about micrometastatic illness in the liver Surgery of Primary Tumors (Medullary Thyroid Cancer) Intervention Recommendation Comment Primary tumor resection Locoregional illness Recommend Advanced illness Consider Nodal disease Bilateral central neck dissection Recommend For locoregional illness Consider For advanced disease Ipsilateral lateral neck dissection Recommend If proof of nodal disease on preoperative imaging Consider If tumor is 91 cm or there’s evidence of constructive nodes within the central neck Contralateral lateral neck dissection Recommend If proof of nodal illness on preoperative imaging Consider If bilateral tumors, or extensive lateral adenopathy on the aspect of the tumor Prophylactic surgery (medullary thyroid cancer) Preoperative Test for pheochromocytoma, Recommend All sufferers should be examined for a hyperparathyroidism pheochromocytoma (fractionated metanephrines in plasma or urine) and hyperparathyroidism (serum calcium) preoperatively erectile dysfunction va disability order 20 mg cialis jelly with amex. 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