What are the NCCN treatment guidelines for medullary thyroid carcinoma (MTC)?

Updated: May 14, 2020
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The National Comprehensive Cancer Network (NCCN) guidelines recommend total thyroidectomy and bilateral central neck dissection (level VI) for all patients with medullary thyroid carcinoma whose tumor is 1 cm or greater or who have bilateral thyroid disease, as well as the following [33] :

  • Therapeutic ipsilateral or bilateral modified neck dissection for clinically or radiologically identifiable disease (levels II–V)
  • Prophylactic ipsilateral modified neck dissection for high-volume or gross disease in the adjacent central neck may be considered

External beam radiation therapy (EBRT) is an option for treatment of incomplete tumor resection when further surgical resection is no longer possible. EBRT can also be considered for adjuvant treatment of extrathyroidal extension (T4a or T4b) with positive margins.

Other therapy considerations are as follows:

  • Total thyroidectomy is recommended and neck dissection can be considered for those whose tumor is <1 cm and for unilateral thyroid disease
  • Radioiodine (131I) therapy is not effective
  • Suppression of TSH is not appropriate; TSH is kept in the normal range by adjusting levothyroxine dose
  • Pheochromocytoma removal prior to thyroid surgery by laparoscopic adrenalectomy, and treatment preoperatively with alpha-adrenergic blockade (phenoxybenzamine) or with alpha-methyltyrosine to avoid a hypertensive crisis during surgery

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