S138 – Treatment Controversy Incidental Micro-Medullary Carcinoma

Abstract

Objectives 1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature. Methods This case is a 33-year-old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery. Results The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease-free. Conclusions Medullary thyroid carcinoma is a well-described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.