Researchers reported a rare case of medullary thyroid carcinoma (MTC) with normal serum calcitonin (CT) and carcinoembryonic (CEA) levels, as published in the Journal of Surgery Open.

They noted that typically, MTC is accompanied by aggressiveness and metastasis, along with increased CT and CEA levels. Both measurements are considered to be useful biomarkers for the diagnosis and follow-up of patients with MTC.

“In the literature, only a few cases of MTC associated with normal calcitonin level have been reported,” the authors said. “In the presenting case, the serum calcium level was also within the normal range. It is not always possible to exclude the diagnosis of MTC by normal serum CT level.”

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In hereditary cases, MTC typically presents bilaterally and with locoregional as well as lymph node metastasis. The case reported here did have a family history of MTC, with a well-defined nodule in the right side and 2 additional nodules in the left mid and lower thirds.

Fine needle aspiration cytology, an approach for thyroid nodules but with less diagnostic value specifically for MTC, led to a suspicion of papillary thyroid carcinoma. However, the patient had no metastasis, and normal CT and CEA levels.

Surgery is the treatment approach of choice for MTC, and early diagnoses are important to a good prognosis. The patient in this report underwent total thyroidectomy and the histopathological examination showed multifocal bilateral medullary thyroid carcinoma.

There was no metastasis and the patient had an uneventful follow-up without recurrence 6 months later. The authors suggest that given that the pathophysiology of MTC is still unclear, greater awareness regarding MTC with normal CT levels is important to achieving a rapid diagnosis and better prognosis.

Reference

Salh A, Ahmed S, Ahmed F, et al. Medullary thyroid carcinoma with normal serum calcitonin and carcinoembryonic levels; a case with review of literature. Int J Surg Open. Published online January 28, 2022. doi:10.1016/j.ijso.2022.100443