Endocrine Abstracts

Background

The management of patients with medullary thyroid cancer (MTC) has an important endocrinological aspect, because MTC can be a manifestation of multiple endocrine neoplasia syndrome (MEN), a genetically determined pathology with an autosomal dominant inheritance. MEN-2 syndrome is characterized by of MTC as a permanent feature, the combination with pheochromocytoma and/or adenoma of the parathyroid glands. The aim of the study was to determine the clinical and laboratory characteristics of patients with medullary thyroid cancer in order to form a database of patients with MEN2A.

Materials and methods

The research is carried out of the state program “To develop and implement effective technologies for the diagnostic detection and observation of patients with MEN2A.” According to the Belarusian Cancer Register in 1987–2017 years 26930 new cases of thyroid cancer were identified (4899 men and 22 031 women), the share of MTC was 2.2% (591 people). Examination of 79 patients with MTC was carried out. Patients collected and recorded in the form of primary reporting data of anamnesis and general clinical examination.

Results

In 16.5% (13 patients) hyperplasia of regional lymph nodes was detected, a puncture biopsy was performed, and in 5.0% (4 patients) a relapse of the disease was revealed. No data were found for parathyroid hyperplasia. 91.1% (72 patients) underwent ultrasound of internal organs, revealed minor abnormalities. Computed tomography of the chest and internal organs was performed in 39.2% (31 patients). Data for tumor pathology and progression of the disease have not been established, but in 7.6% (6 patients) adrenal formations were revealed, which requires further examination. The TSH level was normal in 46.0% (36 patients). 8.9% (7 patients) simultaneously had two histotypes of cancer: medullary and papillary, so they had to receive a suppressive dose of levothyroxine. TSH was suppressed in 43.0% (34 patients), hypothyroidism was noted in 2.5% (2 patients). 55.7% (44 patients) take calcium and vitamin D supplements. Differences in the content of serum calcium in patients depending on the intake of calcium and vitamin D were not established (2.31 ± 0.04 vs 2.31 ± .03; P>0.05). Transient postoperative and manifest hypoparathyroidism was found in 19.0% (15 patients). In 7.6% (6 patients) calcium levels do not reach the lower limit of normal, which is associated with a lack of adherence to treatment.

Conclusions

Patients with MTC require a multidisciplinary laboratory and instrumental examination due to the possible combined pathology, which, in turn, determines the subsequent therapeutic and surgical treatment of patients.