A 26-years women presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. The preferred treatment should be:
MEDULLARY CARCINOMA THYROID Neuroendocrine carcinoma arising from parafollicular &;C&; cells of thryoid Parafollicular &;C&; cells are derived from the ultimobranchial bodies & secrete calcitonin &;C&; cells are concentrated superolaterally in throid lobes, from where MTC usually develops. Most MTCs (75-80%) arise sporadically Spread is both lymphatic & hematogenous MC site of metastasis Liver. Clinical features High level of serum Calcitonin & CEA Cervical lymph nodes at the time of presentation (LN involvement, thyroid and blood borne metastases occurs early) Diarrhoea at the time of presentation Amyloid in stroma histologically MEN setting: Evidence of Pheochromocytoma/Hyperparathyroidism/Thyroid cancer in Family Discovery of medullary carcinoma thyroid makes family surveillance advisable Diagnosis Diagnosed by FNAC I131 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 hypocalcemia. Treatments : Total Thyroidectomy+ Central LN dissection+/- Ipsilateral MRND if tumor > 1 cm If nodes are positive on ipsilateral side: Bilateral MRND Follow-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 Ref: Sabiston 20th edition Pgno: 909
Removal of the involved node, the isthmus, a poion of the opposite bone and he enlarged lymph node
Removal of the involved lobe, the isthmus, a poion of the opposite lobe, and he enlarged lymph node
Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node
Total thyroidectomy and irradiation of the cervical lymph nodes
Endocrinology and breast