Medullary thyroid carcinoma: surgical management of primary tumor and locoregional recurrence

Medullary thyroid carcinoma is a rare neoplasm (3-9% of all thyroid tumors). Surgery represents the only strategy for potential cure of the disease in whichi. Medullary thyroid carcinoma in which locoregional lymph node metastases are an early occurrence cannot be treated with radioiodine therapy and it is minimally sensitive to chemotherapy and external beam radiation therapy. Therefore total thyroidectomy with lymphadenectomy is the treatment of choice. Ipsilateral laterocervical lymphadenectomy is essential for neoplasms > 10 mm in size in case of central and ipsilateral laterocervical lymph node involvement; bilateral laterocervical lymphadenectomy should be performed in all patients with bilateral lymphadenopathy and in some cases of MEN 2B. In recurrence, reoperation is the single possible treatment with satisfactory results in terms of prognosis.