Endocrine Abstracts

Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells. Metastatic spread commonly occurs to cervical lymph nodes.

Methods: This is a retrospective study including 8 cases of medullary carcinoma of the thyroid gland between 2000 and 2020.

Results: The sex-ratio (M/F) was 0.125. The mean age of our patients was 55.87 years. No personal or family history of multiple endocrine neoplasm was found. Symptoms included: a cervical mass in all cases, dyspnea in 2 cases and a flush syndrome in 2 cases. On physical exam, a level 2 lymph node was palpated in 3 cases. On ultrasound, thyroid nodules were classified as EU-TIRADS 4 or 5 nodules with lymph node showing malignant features in 4 cases. Fine-needle aspiration was performed in 3 cases and did not suggest the diagnosis of a MTC. Surgery included: total thyroidectomy with central lymph node dissection in 1 case, central and lateral lymph node dissection in 7 cases. It was bilateral in 3 cases. Extemporaneous exam suggested MCT in one case. All patients had lymph node metastases. The tumor mean size was 57mm, multifocal in 1 case, with extra-thyroidal extension in 1 case. There was no evidence of distant metastasis on CT-scan in all cases. There was also no evidence of hyperpathyroidism or pheochromocytoma. Six patients had radiotherapy. There was 1 case of lymph node recurrence and 2 cases of distant recurrences (lung and bone metastases).

Conclusion: In MTC, Surgery is the best treatment option. Patients with MTC should receive lateral lymph node dissection especially when calcitonin levels are elevated, even in the absence of lymph node metastasis on clinical exam and imaging.