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Figure 1. Management of Patients With a Thyroid Nodule
And Histological Diagnosis of Medullary Thyroid Carcinoma
Thyroid nodule:
FNA Diagnosis of MTC
• US of Neck
• Measure serum levels of Ctn and CEA
• DNA analysis for RET germline mutation
RET+
RET–
Absent
Present, Rx at
time of TTX
Evaluate for
HPTH
Ctn >500 pg/mL
TTX with or without cervical LND
depending on US, serum Ctn levels,
and intraoperative findings
Consider EBRT to the neck if
extensive nodal disease, residual
MTC, or extension of MTC
beyond the thyroid
MO: Proceed to TTX
with or without cervical
LND, depending on
neck US results and
serum Ctn levels
Present,
unilateral or
bi-lateral ADX
prior to TTX
Ctn <500 pg/mL
Evaluate for
PHEO
M1, TTX
Clinical trial
Consider EBRT to the
neck if extensive nodal
disease, residual MTC,
or extension of MTC
beyond the thyroid
Imaging procedures
to exclude presence of
metastatic MTC
Treat regional
disease
Patient with
progressive
systemic disease
Systemic threapy
with TKI
