Medullary thyroid cancer (MTC) is an uncommon form of thyroid cancer and responsible for 3%-10% of all thyroid cancers. Special thyroid cells called Para-follicular cells (C cells) that produce calcitonin hormone are accountable for medullary thyroid cancer development. Calcitonin plays the role of controlling bone formation and blood calcium levels, but its action in humans is not very powerful. Calcitonin doesn’t require replacement in adults if the thyroid is removed. Para-follicular cells, unlike other cells in the thyroid, do not concentrate iodine and therefore radioactive iodine therapy is not recommended to treat medullary thyroid cancer.
Symptoms associated with medullary thyroid cancer
Most patients with thyroid cancer do not show any signs. Normally, patients present with a thyroid nodule that on more assessment is found to be cancer. In all thyroid disease, an examination of family history of thyroid cancer, personal history of radiation exposure, or enlarged lymph nodes is important. Your endocrinologist will look for symptoms such as pain, swelling in the neck, difficulty with swallowing, shortness of breath, difficulty with breathing or changes in your voice. Enlarged nodule may lead to difficulty swallowing, choking sensations, or a large mass in the neck. In extremely rare cases, cancer can spread to the nerves that control the voice box and cause hoarseness.
Characteristics of Medullary Thyroid Cancer
Available Treatment for Medullary Thyroid Cancer
- It occurs in 4 clinical settings, i.e. Sporadic, MEN II-A (Sipple Syndrome), MEN II-B and Inherited medullary carcinoma
- Prevalent in females than males (except for inherited cancers)
- Spread to neck lymph nodes is visible early in the disease
- Spread to distant organs happens late and can be to the liver, bone, brain and adrenal medulla
- Not linked with radiation exposure
- Commonly appears in the upper central lobe of the thyroid
- Recurrence can be detected by measuring calcitonin hormone
- Surgery: The best treatment for Medullary Thyroid Cancer is surgery. The aim of the surgery is to remove all disease at first go. A complete resection can be difficult because patients with a nodule will already have lymph node in the neck. The spread of disease can be determined in most patients by their calcitonin levels. These levels are helpful to surgeon in estimating how extensive an operation would be. The minimum suggested surgery for MTC is a Total Thyroidectomy with central lymph node dissection. The procedure involves eliminating the whole of thyroid gland along with the lymph nodes between the carotid arteries on each side and from the hyoid bone to the inominate vessels. Post surgery, it is important to monitor blood levels for calcitonin every 6 months to a year.
- Other Treatments: Radioactive Iodine therapy doesn’t apply to Medullary Thyroid Cancer. Very few patients of Medullary Thyroid Cancer require external beam radiation or chemotherapy. These treatments are necessary for very advanced or severe disease.
There are various treatments available for medullary thyroid cancer, including thyroidectomy. Consult with your endocrinologist
as to which option is best suitable to you.