Management of Postoperative Hypercalcitoninemia in MTC

Abstract

A 62-year-old man, without any signifi cant medical history, presented to a gastroenterologist with chronic diarrhea of 1-year duration. He did not take any medications except for occasional anti-infl ammatory drugs. In general, he felt well. The diarrhea was sometimes associated with hematochezia. The patient's physical examination was normal. The endoscopic work-up (upper endoscopy and colonoscopy) and abdominal ultrasound (US) were normal. Laboratory testing revealed a serum calcitonin (Ct) level of 1000 pg/mL and CEA level was 86.7 ng/mL. Thyroid and neck US showed a posterior right 13 × 10 × 10 mm hypoechoic, irregular thyroid nodule. Furthermore, a right jugular (8 × 3 mm) and a left subclavicular lymph node (47 × 19 mm) were identifi ed. Chest and abdominal computed tomography (CT) scans showed another left jugular lymph node (23 × 20 mm), small mediastinal lymph nodes, and two left adrenal nodules (12 and 18 mm). These fi ndings were highly suggestive of the diagnosis of medullary thyroid carcinoma (MTC). Biologic measurements excluded associated pheochromocytoma and primary hyperparathyroidism (PHPT).Total thyroidectomy with bilateral central and jugular lymph node dissection was performed. Histological examination confi rmed the diagnosis of MTC on the right (primary tumor: 2 cm in diameter), with mild C-cell hyperplasia in the left thyroid lobe and major lymph node invasion (36 out of 52 bilateral lymph nodes were involved: 15 involved nodes out 21 in the central compartment, 17/23 in ipsilateral lateral compartments, and 4/8 in the contralateral lateral compartment).