Medullary Thyroid Cancer: Surgical Risks and Considerations

The mother has malignant thyroid tumor (medullary carcinoma)?

Hello Doctor: My mother is 48 years old and had surgery eight years ago, during which about one-tenth of her thyroid was left intact.
Due to some malignant tumors being too close to the carotid artery, the surgeon did not remove them all, leaving about ten tumors in her body.
Recently, she has experienced an increase in difficulty breathing, and last month, blood tests indicated changes in the tumors.
The doctor has suggested another surgery, but since it was deemed too dangerous to remove those tumors at the time, is it necessary to operate now? If left untreated, will the tumors that have changed worsen? Would the risk of surgery be higher if they deteriorate further? I would appreciate your insights on this matter.
Thank you!

BeBe, 20~29 year old female. Ask Date: 2006/07/13

Dr. Xie Wenhuai reply Surgery

Based on your description, your mother's thyroid malignancy has recurred, and due to symptoms of respiratory distress, it is suspected that the tumor may be compressing the trachea.
This factor may be considered when deciding on a second surgery.
You can discuss your concerns with the attending physician.
Wishing your mother good health.

Reply Date: 2006/07/13

More Info

Medullary thyroid cancer (MTC) is a type of thyroid cancer that arises from the parafollicular C cells, which produce calcitonin. It is important to understand the surgical risks and considerations associated with MTC, especially in the context of your mother's medical history.

Given that your mother has a history of thyroid surgery and has residual tumors, the decision to undergo another surgical intervention should be approached with caution. The presence of tumors close to critical structures, such as the carotid artery, increases the complexity and risk of surgery. Surgical risks can include bleeding, infection, nerve damage (particularly to the recurrent laryngeal nerve, which can affect voice), and complications related to anesthesia.

The recommendation for surgery often hinges on several factors: the size and behavior of the tumors, the presence of symptoms (such as difficulty breathing), and the potential for malignancy. If the tumors are showing signs of change, such as growth or atypical features on imaging or pathology, this could indicate a higher risk of malignancy. In such cases, the risk of leaving the tumors untreated may outweigh the risks associated with surgery.

If left untreated, there is a possibility that the tumors could progress to a more aggressive form of cancer, which could complicate future surgical options and increase the risks associated with surgery. The longer the tumors remain, the more they may invade surrounding tissues, making surgical removal more challenging and risky.

In terms of the necessity of surgery, it is crucial to weigh the potential benefits against the risks. If the tumors are indeed becoming more aggressive or symptomatic, surgical intervention may be warranted to prevent further complications. On the other hand, if the tumors are stable and not causing significant symptoms, a watchful waiting approach may be considered, but this should be closely monitored by healthcare professionals.

Additionally, it is essential to consider the possibility of genetic factors associated with MTC. If your mother has a family history of MTC or related syndromes (such as Multiple Endocrine Neoplasia type 2), genetic counseling and testing may be advisable. This could provide insight into her risk of developing further complications and guide management decisions.

In conclusion, the decision to proceed with surgery should involve a thorough discussion with a multidisciplinary team, including an endocrinologist, a surgeon, and possibly a genetic counselor. They can provide a comprehensive assessment of the risks and benefits, taking into account your mother's specific medical history and the characteristics of the tumors. Regular follow-up and monitoring are crucial, regardless of the decision made, to ensure timely intervention if the situation changes.

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