Behind The Knife: The Surgery Podcast

Clinical Challenges in Endocrine Surgery: Medullar Thyroid Cancer with Special Guest Dr. Kepal Patel

19 snips
Jun 20, 2022
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ADVICE

Essential Workup For Medullary Thyroid Cancer

  • Get calcitonin and CEA and send genetic testing for any medullary thyroid cancer diagnosis.
  • Use cross-sectional imaging when tumor markers and disease volume mismatch to check for distant metastases.
ADVICE

Screen For Pheochromocytoma And Do Genetics First

  • Reflexively screen for pheochromocytoma with plasma or 24-hour urine metanephrines before surgery.
  • Start genetic testing early because up to 25% of medullary cases are familial and it changes preoperative planning.
INSIGHT

Calcitonin Levels Inform Disease Extent

  • Use calcitonin thresholds to estimate disease extent: >50 confirms diagnosis and >500 suggests extrathyroidal disease.
  • Levels around 200 correlate with higher likelihood of nodal involvement and guide staging decisions.
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