Endocrine Abstracts

JOINT227

Medullary thyroid carcinoma is a rare tumor derived from parafollicular cells. Sporadic medullary carcinoma is usually diagnosed as advanced disease because most patients present as a solitary nodule without other signs and symptoms. 70% of patients present with neck metastases, whereas 10% of patients have distant metastases. We will present the case of a 72-year-old female with medullary carcinoma who was initially referred for operative treatment due to multinodous goiter. Upon admission to our institution, in laboratory results we found calcitonin 55810 pg/ml, CEA 1346,1 ng/ml, with normal values of parathyroid and thyroid hormones. A CT scan of the neck was performed, and the voluminous right lobe of the thyroid with hypodensity and calcifications in the lower aspects, sized 38x26x71 mm, was found, as well as conglomerates of pathologically altered lymph nodes. Total thyroidectomy with extended neck dissection was performed. Postoperative PET/CT with 18F DOPA showed secondary deposits localized supra and retroclavicular. Control calcitonin 3 months after the operation was 653 pg/ml, CEA 62 ng/ml, with normal PTH and normal catecholamines in 24h urine. The patient was reoperated on and altered lymph nodes were extirpated. In the further course, high calcitonin and CEA values were maintained, while PET/CT 18F DOPA one year after operative treatment indicated infracm pathological lymphatics. Although patient presented in older age and with exceptionally high calcitonin and CEA values, this is locoregional disease without clinical features of MEN syndrome, only active surveillance is indicated in futher follow up.