15
Figure 3. Management of Patients Following Thyroidectomy
For Persistent or Recurrent Medullary Thyroid Carcinoma
Status TTX
• Physical exam and US of the neck
• Measure serum levels of Ctn, CEA,
TFTs, and TSH every 6-12 months
Ctn >150 pg/mL
Ctn undetectable or
within normal range
• Physical exam and US of
neck every 6 months
• Measure serum Ctn and
CEA every 3 to 6 months to
determine doubling times
• If serum Ctn >150 pg/mL
perform imaging procedures
to detect recurrent MTC
• Consider treating regional
disease by surgical resection,
EBRT, or other modalities
depending on site and
associated risks
• Patients with progressive
systemic disease should be
treated with systemic therapy
(preferentially a TKI), or
participate in a clinical trial
Imaging procedures
to detect metastases
• Physical exam and
repeat imaging
studies every 6-12
months
• Measure serum
Ctn and CEA
every 3-6 months
to determine
doubling times
If physical exam and US
remain normal, evaluate
every 6 months for 1 year,
then annually
Imaging negative Imaging positive
Detectable Ctn but <150 pg/mL
and no evidence of persistent or
recurrent MTC on physical exam
or US
