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

Authors

  • Natawat Narueponjirakul Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Pasurachate Samorn Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Keywords:

: Medullary thyroid carcinoma, outcome, management

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.

Downloads

Download data is not yet available.

References

Pacini F, Castagna MG, Cipri C, Schlumberger M. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol) 2010;22:475-85.

Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1,252 cases. Cancer 2006;107:2134-42.

Sippel RS, Kunnimalaiyaan M, Chen H. Current management of medullary thyroid cancer. Oncologist 2008;13:539-47.

Shepet K, Alhefdhi A, Lai N, Mazeh H, Sippel R, Chen H. Hereditary medullary thyroid cancer: ageappropriate thyroidectomy improves disease-free survival. Ann Surg Oncol 2013;20:1451-5.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelinesTM) thyroid carcinoma version 2.2013. Pennsylvania: NCCN; 2013.

Kandil E, Gilson MM, Alabbas HH, Tufaro AP, Dackiw A, Tufano RP. Survival implications of cervical lymphadenectomy in patients with medullary thyroid cancer. Ann Surg Oncol 2011;18:1028-34.

Essig GF Jr, Porter K, Schneider D, Debora A, Lindsey SC, Busonero G, et al. Fine needle aspiration and medullary thyroid carcinoma: the risk of inadequate preoperative evaluation and initial surgery when relying upon FNAB cytology alone. Endocr Pract 2013:19:920-7.

Daniels GH. Screening for medullary thyroid carcinoma with serum calcitonin measurements in patients with thyroid nodules in the United States and Canada. Thyroid 2011;21:1199-207.

Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009;19:565-612.

Greenblatt DY, Elson D, Mack E, Chen H. Initial lymph node dissection increases cure rates in patients with medullary thyroid cancer. Asian J Surg 2007;30:108-12.

Downloads

Published

2023-10-17

How to Cite

1.
Narueponjirakul N, Samorn P. Medullary thyroid carcinoma in King Chulalongkorn Memorial Hospital: Natural history, management, and outcome. Chula Med J [Internet]. 2023 Oct. 17 [cited 2024 Oct. 12];65(1). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/1069