Diagnosis
Medullary thyroid carcinoma. Nodular lesion of the right thyroid lobe (TI-RADS 3). Bilateral thyroid nodules (TI-RADS 2/2).
Patient:
Female, 37 years old, Kazakhstan
Physician:
Prof. Dr. med. Henning Dralle, Head of Endocrine and Visceral Surgery, University Hospital Essen
Patient’s Inquiries:
Fine-needle aspiration cytology of the thyroid nodule indicated signs of medullary thyroid carcinoma, categorized as Bethesda VI (TBSRTC 2017). Laboratory blood tests show elevated tumor markers:
- Carcinoembryonic antigen (CEA): 7.19 ng/mL
- Calcitonin: 156.00 pg/mL
Surgical removal of the thyroid gland was recommended locally.
- Is a total thyroidectomy always required when medullary thyroid cancer is suspected?
- What is the risk of permanent voice loss or vocal cord dysfunction following surgery?
Expert Opinion by Prof. Henning Dralle:
I have thoroughly reviewed the patient's diagnostic reports and ultrasound imaging. The clinical presentation is definitive for medullary thyroid carcinoma, as confirmed by the elevated serum calcitonin and CEA levels alongside the Bethesda VI cytological findings. Surgical treatment should be scheduled as soon as possible.
During surgery, an intraoperative frozen section biopsy must be performed to guide the extent of surgical resection. Based on the intraoperative histopathology results, a decision will be made regarding complete or partial thyroid removal. According to our clinical research, approximately one-third of patients with medullary thyroid cancer present without characteristic tumor desmoplasia. In these specific cases, a hemithyroidectomy with ipsilateral central neck dissection—removing the affected thyroid lobe and adjacent lymph nodes—is sufficient. However, if desmoplasia is identified on the intraoperative frozen section, a total thyroidectomy with lymph node dissection becomes mandatory.
We routinely perform thyroid surgeries under continuous intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve. Utilizing this advanced technology reduces the risk of intraoperative nerve injury to virtually zero.
Treatment Rendered:
Intraoperative frozen section analysis revealed no evidence of desmoplasia. Consequently, a right hemithyroidectomy accompanied by ipsilateral neck dissection was successfully performed. Two days following surgery, the patient was discharged from the hospital in good clinical condition without complications.