Medullary thyroid carcinoma in King Chulalongkorn Memorial Hospital: Natural history, management, and outcome

Abstract

Background: Medullary thyroid carcinoma (MTC) is rare and a diagnosis difficulty disease. In term of natural history, management, and outcomes among Thai patients, the data were scarce.

Objectives: We aimed to review natural history, management, and clinical outcome of MTC patients in the tertiary care hospital.

Methods: Retrospective study of medullary thyroid carcinoma patient was performed in our hospital from January 1, 2002 to December 31, 2011. Medical records has been carefully reviewed. Demographic data, clinical presentation, investigation, management and outcomes has been collected.

Results: Sixteen MTC patients were taken into account for 1.1% of all thyroid carcinoma of the hospital, 12 were women. Mean age was 51.9 years. All of them were sporadic cases. 75.0% of cases present with thyroid nodule. 87.5% underwent fine needle aspiration (FNA). Preoperative diagnosis was made only 25.0% by FNA. Preoperative serum calcitonin levels and CEA levels were measured in 4 and 5 patients; the levels were increased in all cases. Regarding mode of treatment, total thyroidectomy, near total thyroidectomy and subtotal thyroidectomy were applied for 11, 2 and 2 patients respectively. In patients with advance disease, cervical lymphadenectomy was adopted (2 prophylactic central neck dissection, 4 prophylactic ipsilateral neck dissection, 6 therapeutic ipsilateral neck dissection and 1 contralateral neck dissection). Median follow up period was 41 months. There was no mortality observed.

Conclusions: Since, lack of an accurate preoperative diagnosis, the treatment varies especially in cervical lymphadenectomy procedures, depending on surgeon’s preferences. However, favorable outcomes have been achieved.