A 52 year female pt. presents with symptoms of pheochromocytoma. She also has a thyroid carcinoma. Her thyroid Ca is of which type -
Pt. is having MEN syndrome type II.
MEN syndrome is associated with medullary Ca of thyroid.
MTC with MEN syndrome present at a younger age and are multicentric and bilateral.
These patients with familial MTC can be recognized early by identifying RET proto-oncogene mutation and death can be prevented from thyroid carcinoma by performing prophylactic thyroidectomy.
Schwartz writes - "Total thyroidectomy is indicated in RET mutation carriers once the mutation is confirmed. The procedure should be performed before age 6 years in MEN 2A patients. Central neck dissection can be avoided in children who are RET positive and calcitonin negative with a normal ultrasound examination. When the calcitonin is increased or the ultrasound suggests a thyroid cancer, a prophylactic central neck dissection is indicated."
Anaplastic
Medullary
Follicular
Papillary