Fig. 12.1
Medullary thyroid cancer in the right lobe. Nodule was assessed at ultrasonography as not suspicious: echotexture was spongiform and margins were regular (a). Elastography showed green color (b)
Fig. 12.2
Medullary thyroid cancer of the right lobe presenting as mixed nodule at ultrasonography with irregular margins (a) and mixed vascularity at Doppler ultrasonography (b)
12.2 Therapy and Follow-Up
The initial treatments of MTC include total thyroidectomy and central neck nodal and, in selected cases, lateral neck nodal dissection. This approach is needed for an appropriate treatment which strongly affects on patient prognosis [1].
Overall, prognosis of patients affected by MTC is poorer than that of subjects with differentiated thyroid malignancy. As above mentioned, these data depend on initial surgical removal of thyroid gland and eventual cervical metastases and the delay of the diagnosis.
Follow-up of these patients is based on periodical measurement of serum calcitonin and other potential markers, such as CEA and procalcitonin [6, 7]. Neck ultrasonography over time is the main imaging tool, while computed tomography (CT) and PET/CT could improve the localization and stratification of the risk of more aggressive disease (Figs. 12.3 and 12.4) [8]. Generally, imaging is required only in patients with postoperative calcitonin >150 pg/ml.
Fig. 12.3
CT performed for staging in a patient with medullary thyroid carcinoma demonstrates bilateral hypodense nodules (red arrows). The larger nodule was located in the right thyroid lobe (a). Bilateral enlarged cervical lymph nodes were also evident (yellow arrows) at CT imaging (b). Final diagnosis after surgery was multifocal medullary thyroid carcinoma with cervical lymph nodal metastases
< div class='tao-gold-member'>
Only gold members can continue reading. Log In or Register to continue
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
