Thyroid Research Thyroid Research Archive Thyroid Cancer

Prognosis is good in patients with an incidentally detected medullary thyroid carcinoma

(July 2004)

The background of the study. Patients with a nodular goiter who are operated on are sometimes unexpectedly found to have a small thyroid carcinoma. Most are papillary or follicular carcinomas, but a few are medullary carcinomas. The study was done to review the clinical findings and course of patients with an incidental medullary carcinoma.

How the study was done. Among 261 patients with medullary carcinoma seen at a single hospital in Germany, the carcinoma was incidental in 15. The diagnosis was based on histology and immunostaining (positive for calcitonin and negative for thyroglobulin).

The results of the study. In 11 patients, surgery was for a multinodular goiter; they underwent bilateral partial or subtotal thyroidectomy. In three patients, surgery was for a single hypofunctioning nodule; two of these patients underwent thyroid lobectomy and one bilateral partial thyroidectomy. One patient was operated on to remove a hyperfunctioning adenoma; a small medullary carcinoma was found adjacent to the adenoma. The carcinomas ranged in size from 0.1 to 2.5 cm; most were ≤0.8 cm. No patient had a RET proto-oncogene mutation.

During a 0.5- to 10-year follow-up period (mean, 4.6), one patient had a recurrence of tumor in the neck, and underwent a second operation. At last follow-up, all the patients were alive, and none had evidence of persistent or recurrent medullary carcinoma.

The conclusions of the study. Patients in whom an incidental medullary thyroid carcinoma is detected during surgery for other thyroid disorders have a good prognosis.

The original article. Raffel A, Cupisti K, Krausch M, Wolf A, Schulte KM, Roher HD. Incidentally found medullary thyroid cancer: treatment rationale for small tumors. World J Surg 2004;28:397-401.