SHM Converge Scientific Abstract ePoster Gallery-The Dilemma of the Microcarcinoma of Medullary Thyroid Cancer Management

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A 68-year-old woman had a stable, small right-sided thyroid lump for 7 years without symptoms of thyroid dysfunction. Exam showed a hard nodule that moved with swallowing, and she had no family history suggestive of thyroid cancer, pheochromocytoma, or calcium disorders. Over several years, she underwent thyroid ultrasound, thyroid function tests, calcitonin, CEA, and four fine-needle aspiration biopsies because of concern for malignancy. The first three biopsies showed chronic lymphocytic thyroiditis with atypical cells and borderline elevated calcitonin and CEA. The fourth biopsy suggested follicular neoplasm, but calcitonin staining was positive, supporting medullary thyroid carcinoma (MTC).  <br /><br />Ultrasound showed a small hypoechoic right thyroid nodule with calcification. CT and MRI later showed a contrast-enhancing thyroid nodule and enlarged cervical lymph nodes. Because MTC can be associated with MEN-2 syndrome, she had further evaluation including calcium, PTH, vitamin D, and thyroid tests, and was referred for RET gene testing and genetic counseling.  <br /><br />She underwent total thyroidectomy. Pathology confirmed a 0.8 cm microcarcinoma of the right thyroid lobe, with positive synaptophysin and TTF-1 staining consistent with MTC. After surgery, calcitonin and CEA normalized, and she remained clinically euthyroid on levothyroxine.  <br /><br />The report highlights that medullary thyroid microcarcinoma is uncommon and its clinical significance and management remain debated. The authors emphasize the value of calcitonin and CEA testing, evaluation for MEN-2, and postoperative biomarker monitoring to assess persistence or progression of disease.

Asset Subtitle

Soe P. Winn

Meta Tag

Author List Kyaw Z. Lin, May Myat Hnin Aung, Soe P. Winn, Tin Tun, Wai Wai Mon, Wutyi Hlaing

Category Clinical Vignettes

Concept Medullary Thyroid Carcinoma

Concept Micro Medullary Thyroid Carcinoma

Concept Thyroid Ultrasound

Concept Fine Needle Aspiration Biopsy

Concept Calcitonin

Distinguished Non-Finalist

Presenter Organization University of Medicine 1, Yangon

Presenting Author Soe P. Winn

Track Adult

Keywords

medullary thyroid carcinoma

thyroid microcarcinoma

calcitonin

CEA

thyroid nodule

fine-needle aspiration

MEN-2 syndrome

RET gene testing

total thyroidectomy

cervical lymph nodes

Medullary Thyroid Carcinoma

Micro Medullary Thyroid Carcinoma

Thyroid Ultrasound

Fine Needle Aspiration Biopsy

Calcitonin