Medullary thyroid microcarcinoma recommendations for treatment – A single-center experience

Abstract

Conflicting recommendations exist regarding lymph node (LN) surgery in microMTC (or=10pg/ml) and pentagastrin-stimulated calcitonin levels (sCT:>100pg/ml) were selected for initial surgery. None of the patient was a member of any known MTC family. Biochemical and morphological data of microMTC were compared with 146 patients with C-cell hyperplasia (CCH). MicroMTC (tumor diameter: 4.2+/-2.6mm; unifocal:68; multifocal:29) was documented in 97 of 159 (61%) MTC patients. In 11 (11%) patients, 1-19 LNs were involved. Correlating bCT and sCT levels neither predicted N-stage, nor differentiated between microMTC and CCH. The biochemical discrimination cannot be made between patients with CCH and MTC, and patients with MTC with/without LN metastasis. Thus, thyroidectomy and central neck dissection is indicated in patients with "mildly" elevated sCT levels (or=560pg/ml) must be treated as "palpable" MTC (LN positive: 10 of 54 patients [18.5%]).