Treatment of medullary carcinoma thyroid is:
Ans. c. Surgery only Treatment of medullary carcinoma thyroid is total thyroidectomy + central LS dissection +- ipsilateral MRND if tumor >1 cm0. If nodes are positive on ipsilateral side bilateral MRND should be done."I131 scan is of no use as MTC is TSH independent."Medullary Carcinoma Thyroid* Neuroendocrine carcinoma arising from parafollicular 'C' cells of thyroid* Parafollicular 'C' cells are derived from the ultimobranchial bodies and secrete calcitonin* 'C Cells are concentrated superolaterally in thyroid lobes, from where MTC usually develops* Most MTCs (75-80%) arise sporadically* Spread is both lymphatic and hematogenous* MC site of metastasis: LiverMedullary Carcinoma ThyroidSporadic: 80%degFamilial: 20%deg(Non-MEN setting/ MEN-2A/MEN-2B)* Originate in one lobe* Seen in 6* decade* RET protoncogeneQ mutation* Multicentric and bilateral* Occur in younger age* Associated with C-cell hyperplasia* RET protoncogene mutationClinical features:Medullary carcinoma should be suspected1. High level of serum Calcitonindeg and CEA2. Cervical lymph nodes at time of presentation (LN involvement, thyroid and blood borne metastases occurs early)03. Diarrhea at the time of presentation.4. Amyloid in stroma histologically.5. MEW setting: Evidence of Pheochromocytoma/Hyperparathyroidism/Thyroid cancer in family. (Discovery of medullary carcinoma thyroid makes family surveillance advisable)degDiagnosis:* Diagnosed by FNAC* l!JI scan is of no use as MTC is TSH independent.* Tumor marker: Calcitonin is raised in almost all cases of MTC* Calcitonin excess in MTC is not associated with hypocalcemiaTreatment:Total thyroidectomy + Central LN dissection +- Ipsilateral MRND if tumor >1 cm if nodes are positive on ipsilateral side: Bilateral MRNDFollow up:Level of Calcitonin falls after resection and is raises again in cases of recurrence, used for follow up.Prognosis:* MTC is associated with poor prognosis.
Surgery and radiotherapy
Radiotherapy and chemotherapy
Surgery only
Radioiodine ablation
Thyroid Malignancies