Related Experiment Videos
Two cases of medullary thyroid carcinoma
1Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. michelle_jong@notes.tish.gov.sg
Introduction:
Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy but accounts for a significant mortality. We present 2 cases of MTC and review the literature regarding its management and genetic screening.
Clinical Picture:
Patient 1 presented after a routine health screening and subsequently was found to have a germline mutation for MEN 2A. Patient 2 presented with sweating irritability and a thyroid mass which illustrates the progressive relentless nature of the disease and highlights current imaging practice.
Treatment:
Both patients underwent extensive surgery and received postoperatively ablative dose of radioactive iodine. Patient 2 also had a large dose I-131 MIBG therapy and further surgery.
Outcome:
In Patient 1, postoperative calcitonins remained elevated indicating residual disease. Patient 2 underwent further radioguided surgery; however, his postoperative calcitonins remained elevated.
Conclusion:
MTC can be relentless. Routine genetic screening of all patients with MTC, Tc-99m pentavalent (V) DMSA imaging, near total thyroidectomy with routine central neck dissections and removal of all lymph nodes in the central neck compartment should be performed.