Article Type
Article
Abstract
Background: Medullary Thyroid Carcinoma(MTC) had special entity in thyroid oncology because of unresponsiveness to Radioiodine and TSH suppression. The tumour originates from parafollicular C cells, not follicular epithelium, and that single histogenetic difference accounts for most of what makes this disease clinically difficult. Cure, when it happens, comes from surgery. When surgery is inadequate, the options that remain are limited. Most cases are sporadic. The minority with germline RET mutations; the hereditary forms; tend to present differently and demand a distinct pre-operative protocol, particularly regarding co-existing endocrine pathology.
Methods: Between January 2014 and February 2025, 131 patients underwent surgery for MTC at Al-Ramadi Teaching Hospital. Their records formed the basis of this analysis. Source documents included operative notes, final histopathology reports, and clinic correspondence. Those unfit for operative management were excluded.
Results: The cohort was 61.3% female, with a mean age of 39.9 years (SD 12.96); younger than most published sporadic MTC series. Median tumour size was 4 cm. Sixty patients had multifocal disease; thirteen had penetrated beyond the thyroid capsule. Cervical nodal involvement was documented in 85 patients (64.9%), with a median of four positive nodes per patient; 63 cases showed ipsilateral-only spread, while 22 had contralateral or bilateral involvement. At the time of index surgery, 29 patients (22.1%) had established distant metastatic disease. Seventeen patients developed recurrence; 13 of these were local failures, most arising within 12 months of surgery. Estimated mean disease-free survival reached 56.5 months across the cohort. On multivariate analysis, age at diagnosis, distant metastasis at presentation, and the side of nodal involvement; not the number of nodes — each independently influenced DFS.
Conclusions: The demographic profile here sits outside the sporadic MTC literature in two ways; younger age and female predominance and we cannot fully account for either from these data. The finding that nodal laterality, rather than nodal burden, shaped survival has practical implications for neck dissection planning and raises questions about whether current staging adequately captures this distinction. The role of hemithyroidectomy in genuinely low-risk MTC is not settled by this dataset, but it is worth asking.
Keywords
Thyroid cancer, Medullary carcinoma, Neck dissection, Disease-free survival, Locoregional recurrence
Recommended Citation
Alheti, Omar T. Abdel-moneim
(2026)
"Medullary Thyroid Carcinoma: Patterns of Disease, Recurrence, and Distant Spread,"
Muthanna Medical Journal: Vol. 13:
Iss.
3, Article 14.
Available at:
https://muthmj.mu.edu.iq/journal/vol13/iss3/14
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
