Persistent Or Recurrent Disease

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Patients who present with palpable MTC often have elevated calcitonin levels following primary surgery, indicating residual or recurrent MTC. Currently, there is no defined role for chemo- or radiation therapy in these patients. Reoperation for patients with recurrent disease can be done with curative or palliative intent. Evidence of distant metastases is a contraindication to surgery unless some palliative benefit can be identified (Figure 17-10). Two such indications are to prevent compromise of the airway and to debulk large tumors that cause profuse, intolerable diarrhea secondary to hormone secretion. If no evidence of distant metastases is found in a patient who has not had previous cervical node dissections, re-exploration of the neck with completion of node dissection is an option for patients with persistent or recurrent elevations of calcitonin. At our institution, metastatic workup consists of neck, chest, and abdominal CT or MRI. We have not found octreotide, technecium/ thallium, or [18F]fluorodeoxyglucose positron emis

Figure 17-10. Distant metastatic disease in patients with medullary thyroid carcinoma (MTC). A, Radiograph of lymphangitic pulmonary spread in a child with multiple endocrine neoplasia (MEN) type IIB and MTC. B, Sonogram of solitary brain metastasis in a patient with MEN type IIA and MTC. C, Multiple skeletal metastases in a patient with sporadic MTC. Reproduced with permission from Moley JF, Lairmore TC, Phay JE. Hereditary endocrinopathies. Curr Probl Surg 1999;36:653-764.

Figure 17-10. Distant metastatic disease in patients with medullary thyroid carcinoma (MTC). A, Radiograph of lymphangitic pulmonary spread in a child with multiple endocrine neoplasia (MEN) type IIB and MTC. B, Sonogram of solitary brain metastasis in a patient with MEN type IIA and MTC. C, Multiple skeletal metastases in a patient with sporadic MTC. Reproduced with permission from Moley JF, Lairmore TC, Phay JE. Hereditary endocrinopathies. Curr Probl Surg 1999;36:653-764.

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