Two cases of medullary thyroid carcinoma.

Introduction: Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy but accounts for a significant mortality .We present 2 cases of MTC and review the literature regarding its management and genetic screening. Clinical Picture: Patient 1 presented after a routine health screening and subsequently was found to have a germline mutation for MEN 2A. Patient 2 presented with sweating irritability and a thyroid mass which illustrates the progressive relentless nature of the disease and highlights current imaging practice. Treatment: Both patients underwent extensive surgery and received postoperative ablative dose of radioactive iodine. Patient 2 also had a large dose I-131 MIBG therapy and further surgery. Outcome: In Patient 1, postoperative calcitonins remained elevated indicating residual disease. Patient 2 underwent further radioguided surgery; however, his postoperative calcitonins remained elevated. Conclusion: MTC can be relentless. Routine genetic screening of all patients with MTC, Tc-99m pentavalent (V) DMSA imaging, near total thyroidectomy with routine central neck dissections and removal of all lymph nodes in the central neck compartment should be performed. Ann Acad Med Singapore 2001; 30:646-50