Outcome of Treatment for Medullary Thyroid Carcinoma—a Single Centre Experience

Abstract

We conducted this study to evaluate the demography, clinical presentation, management and outcomes of medullary thyroid carcinoma (MTC) from the Indian context. This was a retrospective study of patients with MTC managed between January 2008 and December 2016. All pertinent data was collected and the results were analysed using STATA (v.13.1). MTC accounted for 90/2022 (4.45%) patients managed with thyroid cancer during the study period. The mean age of presentation was 40 years (range 14-70 years) with 47 males and 43 females. The most common presentation included goitre with cervical lymphadenopathy seen in 60 patients (66.7%). There were 11 patients (12.2%) with systemic metastasis at presentation. Rearranged during transfection (RET) testing was performed in 71 patients and was positive in 25 (35.2%). The mutations among these patients were seen in the following codons: 634 (12), 804 (8), 790 (3) and 618 (2). Persistent hypercalcitoninemia (calcitonin > 50 pg/ml) was observed in 62/80 (77.5%) patients. Forty patients underwent a meta-iodo-benzyl-guanidine (MIBG) scan in the postoperative period, 10 were positive. The mean duration of follow-up was 32 months and 10 patients defaulted from follow-up. Sixteen patients developed metastasis during the period of follow-up while eight patients expired. The mean survival was 85.75 months (95% CI 78.7-92.7). MTC accounted for 4.5% of thyroid carcinomas in this cohort among which 35% were hereditary. Persistent hypercalcitoninemia following surgery is seen in more than 70% of patients but this does not affect survival. RET screening should be performed for all patients with MTC as curative surgery can be offered for mutation positive offspring.

An audit of medullary thyroid carcinoma from a tertiary care hospital in northwest India

“…from Pisa, Italy concluded that most of the MTCs are diagnosed in a subject with a thyroid nodule, either single or in the context of multinodular goiter, without any other specific symptom; however, untreatable diarrhea and/or flushing can be present in very few mostly advanced cases ( 14 ). A study from India showed goiter with cervical lymphadenopathy was the most common presenting symptom seen in 67% of patients in their cohort ( 15 ). In another Southeast Asian study, 81.2% of the study patients presented with goiter.…”

Medullary Thyroid Cancer: An Experience from a Tertiary Care Hospital of a Developing Country

“…Rates of metastasis were highest in bones followed by lungs and liver (12.5%, 9.4% and 3.1%, respectively), while a study by Cherian AJ et al . [ 15 ] showed that the most common site of metastasis is lung, followed by bone and liver. The studies conducted by S. Roman et al .…”

Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

“…Although surgery is uniformly recommended to treat various types of MTC, the clinicopathological characteristics of SMTC and hereditary MTC are distinct. 4 , 5 …”

“…Although surgery is uniformly recommended to treat various types of MTC, the clinicopathological characteristics of SMTC and hereditary MTC are distinct. 4,5 Presently, the American Thyroid Association Guidelines, the United Kingdom National Multidisciplinary Guidelines for the management of thyroid cancer, and several different individual investigators all recommend total thyroidectomy and central lymph node dissection for patients with MTC. 3,4,6,7 However, the benefit of prophylactic lateral lymph node dissection remains controversial.…”