Endocrine Abstracts

Aim

Assessment of surgery efficacy in patients with MTC.

Methods

We used DNA extracted from 53 patients with MTC. All samples were subjected to PCR. Radio-immunological examination, serum CT measurement was performed by means of commercially available kit RIA DCL-1200. Basal calcitonin (CT) levels higher than 100 picograms per ml and the stimulated CT levels are accepted as pathological and typical of MTC.

Results

We studied the results of surgery in 53 patients operated for the MTC with age range from 11 to 68 year. The study revealed 6 families including 22 (41,5%) with the hereditary MTC, the sporadic one in 31 (58,5%). 12 members of the family were operated at one and the same time and had clinically detailed picture of MTC. In group with hereditary MTC mutations in exons 10, 11, 13 and 14 were demonstrated in 31,8 (7 of 22), 50% (11 of 22), 13,6 (3 of 22) and 4,5% (1 of 22). Three MTC risk groups were devised according to genotype: a high risk group (codons 620 and 634) with ages of 13 and 21 yr at diagnosis; an intermediate risk group (codons 618, 611) with ages of 28 and 37 yr and low risk group (codons 768 and 804) with ages of 48 and 63. Total thyroidectomy and central lymph node dissection was performed in all patients. The metastases to lateral cervical lymph nodes were observed in 19 (35,8%) patients within 1,5–6 months after surgery. Dissection of lateral lymph nodes was performed in connection with clinically overt lymphadenopathy or in patients with the increased post surgery blood CT. CT values were increased (basal 457,8; stimulated 1860 picograms per ml). All patients with recurrences were opereated repeatedly.

Conclusions

The results showed that the management should not be limited to the total thyroidectomy and lymphadenectomy in the central cervical department. The operation should embrace the lateral cervical departments and suprahyoid area too.