|
| Clinical examination | |
| (i) Incidence | |
| 3.0% of all thyroid cancers | |
| (ii) Age at presentation | |
| 5th and 6th decade | |
| (iii) Clinical presentation at diagnosis | |
| (a) Cervical swelling (cervical lymphadenopathy) with midline neck swelling | |
| (b) Hoarseness, dysphagia, and stridor | |
| (c) Paraneoplastic syndromes (uncommon) | |
| (d) Diarrhoea | |
| (iv) Propensity for regional and distant metastasis | |
| (a) Cervical Lymphadenopathy present in 50% cases at the time of diagnosis | |
| (b) Liver, lung, and bone metastasis by hematogenous route in 5–10% cases at the time of diagnosis | |
|
| Diagnostic options | |
| (i) Cytology | |
| (ii) Histopathology followed by immunohistochemical stains | |
| (iii) Serum calcitonin and CEA levels | |
| (iv) 24 hours urinalysis for catecholamine metabolites to rule out asso MEN 2 syndrome | |
| (v) Radiological assessment | |
| (a) Whole body CT scan | |
| (b) Ultrasonography of neck and abdomen | |
| (vi) Screening for missense mutation in RET in leucocytes | |
|
| Management options | |
| (i) Surgery | |
| (a) Total thyroidectomy with or without neck dissection | |
| (b) Prophylactic thyroidectomy in carriers | |
| (ii) Radiotherapy (adjuvant) | |
| (iii) Chemotherapy (palliative in advanced cases) | |
| (iv) Newer modalities (tyrosine kinase inhibitors) | |
| (a) Vandetanib | |
| (b) Cabozantinib | |
|
