Which of the following is the BEST way to treat medullary carcinoma of thyroid?

Treatment of choice for the medullary carcinoma of thyroid is the Total thyroidectomy + modified radical neck dissection. But the option is not provided among options. As total thyroidectomy is provide in option 3 and 4 so answer should be either 3 or 4 Now as far as radioiodine is concerned, it is clearly mentioned in the schwaz that radioiodine is ineffective and about radiotherapy, it has been mentioned that "External beam radiotherapy is controversial, but is recommended for patient with unresectable residual or recurrent tumor" So option 4 i.e. Total thyroidectomy + radiotherapy is the answer here. Ref: Schwaz Surgery 9/e, Page 1368.