A 26-years women presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. The preferred treatment should be:
MEDULLARY CARCINOMA THYROID Neuroendocrine carcinoma arising from parafollicular &;C&; cells of thryoid Parafollicular &;C&; cells are derived from the ultimobranchial bodies & secrete calcitonin &;C&; cells are concentrated superolaterally in throid lobes, from where MTC usually develops. Most MTCs (75-80%) arise sporadically Spread is both lymphatic & hematogenous MC site of metastasis Liver. Clinical features High level of serum Calcitonin & CEA Cervical lymph nodes at the time of presentation (LN involvement, thyroid and blood borne metastases occurs early) Diarrhoea at the time of presentation Amyloid in stroma histologically MEN setting: Evidence of Pheochromocytoma/Hyperparathyroidism/Thyroid cancer in Family Discovery of medullary carcinoma thyroid makes family surveillance advisable Diagnosis Diagnosed by FNAC I131 scan is of no use as MTC is TSH independent Tumor marker: Calcitonin is raised in almost all cases of MTC Calcitonin excess in MTC is not associated with hypocalcemia. Treatments : Total Thyroidectomy+ Central LN dissection+/- Ipsilateral MRND if tumor > 1 cm If nodes are positive on ipsilateral side: Bilateral MRND Follow-Up: Level of calcitonin falls after resection and is raises again in cases of recurrence, used for follow-up Prognosis: MTC is associated with poor prognosis Ref: Sabiston 20th edition Pgno: 909