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Medullary Thyroid Carcinoma

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13 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

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