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- Title
MEDULLARY THYROID CARCINOMA WITH NORMAL CALCITONIN SERUM LEVELS.
- Authors
Oana-Adriana, Matei; Alina-Cristina, Muntean; Reti Zsuzsanna, Medical Doctor
- Abstract
Background: Medullary thyroid carcinoma (MTC) represents an exceptional form of thyroid cancer originated from the neural crest derived parafollicular C-cells whose main secretory substance is represented by calcitonin, which is the principal biochemical marker in MTC. Objective: In rare cases pre-operative serum calcitonin can be negative, thus the aim is to raise awareness of this situations. Material and methods: A 45-year old woman was referred to an endocrinologist for the investigation of a breast nodule. A clinical diagnosis of goiter and micronodule (7*9mm) in the left lobe was made. The thyrotropin stimulating hormone (TSH), thyroxine (FT4) and calcitonin (repeated) levels were within normal limits, and the ultrasound showed a hypoechoic nodule with an irregular outline, microcalcification and intense intra-nodular vascularity. As a result of the suspicious features, the fine needle aspiration biopsy (FNAB) was the next step. The FNAB indicated the presence of a suspicious follicular thyroid nodule with Hurtle cells (Bethesda IV, but could not exclude MTC). Because of these results, a hemithyroidectomy has been performed. The pathologic and immunohistochemical exam showed that the nodule was, in fact, a MTC, by using radioactive calcitonin antiserum against MTC cells. Although the calcitonin remained within normal parameters, a total thyroidectomy and neck dissection became necessary. It was also important to start the screening for the type 2 multiple endocrine neoplasia (MEN) and screen for RET proto-oncogene mutations. Results: Only the immunohistochemical exam with calcitonin antiserum showed the real diagnosis, FNAB being unfortunately not as sensitive in this case. Conclusions: This case illustrates the potential for misdiagnosis of a MTC or a MEN2 syndrome, with possibly lethal consequences for the patient.The primary treatment for MTC is extensive and meticulous surgical resection. Thus, a correct diagnosis spares the patient from multiple interventions and prevents complications. A normal level of calcitonin does not always exclude a MCT.
- Subjects
BETHESDA (Md.); MEDULLARY thyroid carcinoma; NEEDLE biopsy; CALCITONIN; NEURAL crest; BIOMARKERS; SITUATIONAL awareness
- Publication
Acta Medica Marisiensis, 2019, Vol 65, p110
- ISSN
2068-3324
- Publication type
Article