Fifteen-year treatment of metastatic thyroid medullary carcinoma: a case report

Abstract

Medullary thyroid carcinoma (MTC) accounts for 5 to 10% of all thyroid malignancies and shows more aggressive progression than papillary and follicular carcinomas. Average age is approximately 50 years and it is reported that the disease is slightly more common in women. Although the most common initial complaint is painless swelling on the neck, dysphagia, dysphonia and dyspnea may also be seen. It is reported that 75% of MTC cases are sporadic and 25% are familial (multiple endocrine neoplasia type 2A or 2B or isolated familial medullary thyroid cancer).While Ret proto-oncogene mutation is detected in more than 95% of familial medullar cancers, Ret ABSTRACT 160Although very rare, medullary thyroid carcinoma (MTC) is the most aggressive in differentiated thyroid malignancies. We report a 48-year-old male patient with the diagnosis of MTC, who was monitored for fifteen years and showed no serious adverse events due to long-term chemotherapy. Total thyroidectomy, neck dissection, retrosternal nodule excision and pericardiectomy were performed, and radiotherapy was applied to the neck area. Due to progressive metastatic disease cyclophosphamide, dacarbazine, and vincristine were administrated. He tolerated chemotherapy well, and no severe systemic side effects were detected. He died due to multi-organ failure after fifteen years of diagnosis. The only curative treatment is surgery in MTC, however; radiotherapy, chemotherapy, and embolization may be used for patients for whom surgery cannot be performed. Although success rates of systemic chemotherapy are low, it is a treatment option in the progressive metastatic disease.