The preferred operation for initial management of a thyroid nodule that is considered suspicious for malignancy by FNAB is:

C. Total lobectomy and isthmusectomy.

DISCUSSION: There is a consensus that the initial minimum operation for a nodule suspected to be malignant is total lobectomy and isthmusectomy. Partial lobectomy or excision of the nodule is associated with a higher risk of local recurrence if the nodule proves to be malignant. Reoperation on the side of a partial lobectomy can be technically difficult and associated with a higher risk of recurrent nerve injury. Ordinarily, total thyroidectomy is not performed until a conclusive diagnosis of malignancy is established.