Treatment of choice for medullary carcinoma thyroid
Ans) a (Total thyroidectomy) Ref Bailey 25th ed 797Medullary carcinomaTumors of parafollicular cells derived from the neural crest. Amyloid stroma is characteristic.High levels of CEA & calcitonin (useful for follow up)Diarrhoea 30% (due to 5 - hydroxy tryptamine or PG)10 - 20% case familialMEN 2A - Med carcinoma thyroid hyperparathyroidism phaeochromocytoma (adrenal)MEN 2B - MEN 2A +mucosal neuromas +marfanoid habitusLymphnode involvement in 50 - 60% casesBlood bom mets commonTumor is not TSH dependent and do not take radioactive iodine.TreatmentTotal thyroidectomy & either prophylactic or therapeutic resection of the central & bilateral cervical nodes.Familial casesGenetically screened for RET proto oncogene along with S.calcitonin levels.Prophylactic surgery is now recommended for infants with genetic traits.Surgical cases should exclude phaeochromocytoma with urinary catecholamine levelsMost common thyroid cancer - Papillary CaBest prognosis is for Papillary CaClassification of thyroid neoplasmBenignFollicular adenomaMalignantPrimaryFollicular epithelial differentiated - follicular & papillaryFollicular epithelial undifferentiated - AnaplasticParafollicular cells - MedullaryLymphoid cells - LymphomaSecondaryMetastaticLocal infiltration
Total thyroidectomy
Partial thyroidectomy
Subtotal thyroidectomy
Radioactive ablation
Thyroid Gland