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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Presymptomatic thyroidectomy in multiple endocrine neoplasia 2a
O Heizmann1, F-M Haecker, U Zumsteg
1Departement Chirurgie, Allgemeinchirurgische Klinik, Universitätsspital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. oheizmann@uhbs.ch
Summary
Prophylactic total thyroidectomy in genetically diagnosed multiple endocrine neoplasia 2a (MEN 2a) patients effectively identifies and treats early-stage medullary thyroid carcinoma (MTC). Elevated calcitonin levels indicate microscopic MTC, guiding surgical intervention.
Area of Science:
- Endocrinology
- Genetics
- Surgical Oncology
Background:
- Multiple Endocrine Neoplasia 2a (MEN 2a) is a genetic disorder predisposing individuals to medullary thyroid carcinoma (MTC).
- Early detection and intervention are crucial for managing MEN 2a and preventing MTC progression.
Purpose of the Study:
- To assess the efficacy of prophylactic total thyroidectomy in presymptomatic, genetically diagnosed MEN 2a patients.
- To correlate genetic findings and calcitonin levels with MTC presence and stage.
Main Methods:
- Genetic testing identified 14 presymptomatic MEN 2a patients who underwent prophylactic total thyroidectomy.
- Analysis included RET mutation location, calcitonin (CT) levels, surgical outcomes, and histopathology.
Main Results:
- All 14 patients had C-cell hyperplasia and/or MTC, with 11 MTCs (median size 0.2 cm).
- Twelve patients had abnormal peak calcitonin levels, indicating subclinical MTC.
- Post-surgery, 95% achieved biochemical cure, with normal calcitonin levels.
Conclusions:
- Genetic testing enables early identification and prophylactic thyroidectomy for MEN 2a patients.
- Elevated peak calcitonin levels are indicative of microscopic MTC and inform surgical strategy.
