World Journal of Endocrine Surgery

Register      Login

VOLUME 13 , ISSUE 2 ( May-August, 2021 ) > List of Articles


Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation

J Anish Atchaya, Rabishankar Singh

Keywords : Calcitonin, Medullary thyroid cancer, Total thyroidectomy

Citation Information : Atchaya JA, Singh R. Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation. World J Endoc Surg 2021; 13 (2):61-63.

DOI: 10.5005/jp-journals-10002-1401

License: CC BY-NC 4.0

Published Online: 31-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and tuberculous lymphadenitis mimicking metastatic neck nodes. A 26-year-old married woman was diagnosed with sporadic medullary carcinoma of thyroid on fine needle aspiration cytology (FNAC). Preoperative ultrasonography (USG) and contrast-enhanced computed tomography (CECT) neck suggested a metastasis in level IIB neck nodes. Patient underwent total thyroidectomy with central neck dissection with right modified neck dissection type III. Final histopathological report revealed medullary carcinoma thyroid (MTC) with tubercular lymphadenitis, none of 47 nodes retrieved had metastasis. She remains disease free after 2 years following surgery.

  1. Fialkowski EA, Moley JF. Current approaches to medullary thyroid carcinoma, sporadic and familial. J Surg Oncol 2006;94:737–747. DOI: 10.1002/jso.20690
  2. Jeffrey F. Moley, MD, St. Louis, Missouri. Medullary thyroid carcinoma: management of lymph node metastases. J Natl Compr Canc Netw 2010;8(5):549–556.
  3. Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma The American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Thyroid 2015 Jun;25(6):567–610. DOI: 10.1089/thy.2014.0335
  4. Wang TS, Ocal IT, Sosa JA, et al. Medullary thyroid carcinoma without marked elevation of calcitonin: a diagnostic and surveillance Dilemma. Thyroid. 2008;18(8):889–894. DOI: 10.1089/thy.2007.0413
  5. Sand M, Gelos M, Sand D, et al. Serum calcitonin negative Medullary thyroid carcinoma. World J Surg Oncol 2006;4:97.
  6. Brutsaert EF, Gersten AJ, Tassler AB, et al. Medullary thyroid cancer with undetectable serum calcitonin. J Clin Endocrinol Metab 2015;100(2):337-341. DOI :10.1210/jc.2014-3095
  7. Bockhorn M, Frilling A, Rewerk S, et al. Lack of elevated serum carcinoembryonic antigen and calcitonin in medullary thyroid carcinoma. Thyroid 2004;14:468–470. DOI: 10.1089/105072504323150813
  8. Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 1999;229:880–887; discussion 887–888. DOI: 10.1097/00000658-199906000-00016
  9. Machens A, Hinze R, Thomusch O, et al. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 2002;26:22–28. DOI: 10.1007/s00268-001-0176-3
  10. Frank-Raue K, Machens A, Leidig-Bruckner G, et al. Prevalence and clinical spectrum of nonsecretory medullary thyroid carcinoma in a series of 839 patients with sporadic medullary thyroid carcinoma. Thyroid 2013;23:294–300. DOI: 10.1089/thy.2012.0236
  11. Choi EC, Moon WJ, Lim YC. Tuberculous cervical lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma. Br J Radiol 2009 ;82(982):e208-e211. DOI: 10.1259/bjr/91644902
  12. Andrabi SAS, Bhat MH, Farhana B, et al. Tuberculous cervical lymphadenitis masquerding as metastasis from papillary thyroid carcinoma. Int J Endocrinol Metab 2012;10(3):569–572. DOI: 10.5812/ijem.4500
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.