How Do You Determine the Potential for Cure for Medullary Thyroid Cancer? A Novel New Test.

How Do You Determine the Potential for Cure for Medullary Thyroid Cancer? A Novel New Test.

How Do You Determine the Potential for Cure for Medullary Thyroid Cancer? A Novel New Test.

How Do You Determine the Potential for Cure for Medullary Thyroid Cancer MCT? A Novel New Test. Calcitonin Secretory Index CSI.

Endocrine Practice 24(5) May 2108 p.460-467

Filimon S. et al

Dr.Guttler comments on this article.

  1. What is CSI?It takes the serum calcitonin and the size of the cancer nodule to make an index.
  2. CSI in ng/ml/mm was better at predicting early lymph node spread.
  3.  Calcitonin correlated with tumor size and number of positive nodes.
  4. Cure of MCT declines when the CSI is > 30 ng/ml/mm of tumor size.
  5. Recent case had a 44 mm MCT nodule and a serum calcitonin of 5.443 ng/ml. The CSI index to see if she has a chance for a cure.
  6. CSI < 30 resulted in cures in those patients without lymph node involvement.
  7. > 30 CSI there was persistent disease in the lateral neck lymph nodes.
  8. CSI < 30 may be used to tell if someone has a chance to be disease free of MCT after thyroidectomy. High CSI mandates a bilateral lymph node dissection at the first operation.
  9. With no approved routine screening calcitonin for MCT in thyroid nodules evaluation in the USA as too expensive,the first line of defence of missing MCT is cytology.
  10. Pathologists must not miss a patient with MCT when the cytology has eccentric nuclei looking like Hurthle cell neoplasm HCC, but lacking the neucleoli like HCC, and having distinctly different nuclei than follicular tumors.
  11. The diagnosis is obvious on the first biopsy with distinct cell changes not present with regular follicular lesion.
  12. Missing a MCT can result in years of treatment for the wrong cancer and with it unnecessary radioiodine therapy.
  13. It is always wise to get another opinion before preceding with surgery.It may be the wrong surgery or you may not need surgery at all.
  14. Call me at 310-393-8860 or thyroid.manager@protonmail.com for details.
  15. Richard Guttler MD,FACE,ECNU
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