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Old 08-14-2011
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Thyroid Treatment of Medullary thyroid Cancer

guys,
please tell me the proper workup and Tx of suspected Medullary thyroid cancer.

Last edited by cool_atomic; 08-14-2011 at 01:32 AM.
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Old 08-15-2011
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I think , when we find thyroid solitary nodule - we do TSH
If TSH is normal - we do biopsy
After dx of medullary thyroid cancer - we look for MEN tumors , Do CT for pheochromocytoma

And Tx may be removal (not sure )
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Old 08-15-2011
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if u have thyroid nodule
u do TSH/t4 if normal result then biopsy if show medullary ca then do calcitonin (familly hx of medullary thyroid ca ) then MEN 2b ix ct

mx :surgical resection (malgnant)

mtb page 115
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Old 08-15-2011
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Quote:
Originally Posted by miss patho View Post
if u have thyroid nodule
u do TSH/t4 if normal result then biopsy if show medullary ca then do calcitonin (familly hx of medullary thyroid ca ) then MEN 2b ix ct

mx :surgical resection (malgnant)

mtb page 115
In addition to the sporadic Thyroid Medullary Ca, If a pt present with pheochromocytoma then we should also screen them for Thyroid Medullary Ca as a part of MEN synd. In this i guess we will do pentagastrin stimulated Calcitonin essay.
Also there is a Familial type of Medullary Ca which is transmitted as AD trait. For familial cases we will do genetic testing looking for RET proto-oncogene mutations.

Treatment is surgical for all type of Medullary Ca.
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Old 11-16-2011
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Quote:
Originally Posted by cool_atomic View Post
guys,
please tell me the proper workup and Tx of suspected Medullary thyroid cancer.
Good Question!
The answer will depends on if this is a sporadic or an hereditary forms (the latter making up about 20% of the total)

- RET proto-oncogene testing should be performed in all MTC patients (The finding of a germline mutation in this gene indicates a hereditary disease; the mutation should then be sought in all first-degree family members)

- In MEN2A, hyperparathyroidism occurs late and is usually due to parathyroid hyperplasia rather than adenoma. Pheochromocytomas invariably occur later than MTC; they are often bilateral and may be clinically silent, and patients at risk should be screened with measurements of urinary metanephrine excretion.

When the diagnosis of MTC is made based on calcitonin measurements or FNAB, patients should be evaluated for hyperparathyroidism and for pheochromocytoma:

1.- If these diagnoses are satisfactorily excluded, a total thyroidectomy with removal of regional nodes can safely be performed.

2.- In patients with MEN syndrome, surgery should be performed for pheochromocytomas before the surgery for MTC is performed.

Prognostic factors relevant to outcome in MTC include (1) age at diagnosis, (2) male gender, (3) initial extent of the disease (e.g., nodal metastases, distant metastases), (4) tumor size, (5) extrathyroidal invasion, (6) vascular invasion, (7) calcitonin immunoreactivity and amyloid staining in tumor tissue, (8) postoperative gross residual disease, and (9) postoperative plasma calcitonin levels.

Source:
- UpToDate
- Williams Textbook of Endocrinology, 12th ed. 2011
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