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Medullary thyroid cancer: Treatment and prognosis

R Michael Tuttle, MD
Section Editors
David S Cooper, MD
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Patients with medullary thyroid cancer (MTC) can be cured only by complete resection of the thyroid tumor and any local and regional metastases. For patients with residual or recurrent disease after primary surgery or for those with distant metastases, the most appropriate treatment (surgery, chemotherapy, or radiotherapy) is less clear.

This topic review will discuss the role of surgery as primary therapy and the approaches to treating patients with persistent or recurrent MTC after surgery. The approach outlined below is largely in agreement with American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines [1,2]. Recommendations for the timing of thyroidectomy in children with RET mutations and the role of chemotherapy in the treatment of MTC are reviewed elsewhere. (See "Approach to therapy in multiple endocrine neoplasia type 2", section on 'Preventive surgery' and "Medullary thyroid cancer: Chemotherapy and immunotherapy".)


Newly diagnosed patients with medullary thyroid cancer (MTC) should be staged both biochemically and radiologically (algorithm 1). This evaluation is reviewed briefly below and in more detail elsewhere. (See "Medullary thyroid cancer: Clinical manifestations, diagnosis, and staging", section on 'Evaluation'.)

The following tests should be performed:

Measurement of serum calcitonin and carcinoembryonic antigen (CEA) to determine whether they are produced by the tumor, and if so, as a baseline for comparison with results obtained after surgery. Among patients with either sporadic or familial tumors, those with higher preoperative serum calcitonin concentrations have larger tumors and are less likely to have normal serum concentrations after surgery than those with lower preoperative values [3].

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Literature review current through: Nov 2017. | This topic last updated: Nov 04, 2016.
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