MEDULLARY THYROID CARCINOMA DISCOVERED THROUGH ELEVATED CEA IN THE COURSE OF HEALTH SCREENING – A REPORT OF 10 CASES

Abstract

INTRODUCTION
10 cases of sporadic Medullary Thyroid Carcinoma were seen where their initial presentation was asymptomatic elevation of CEA level discovered on health screening.

CASE
6 men and 4 women (ages 36 to 68 years) were found to have elevated CEA levels (2 former smokers). The time between detection of elevated CEA to time of final diagnosis ranged from 2 months to 9 years. Significantly 3 patients had CEA elevation for 8, 8 and 9 years respectively before diagnosis. At diagnosis, 9 patients appeared to have limited disease (confined to the thyroid) in spite of the long duration of CEA elevation. One patient was noted to have lymph node metastases (diagnosed 4 months). This patient had persistent Calcitonin elevation and had a second operation later.

CONCLUSION
The long duration of asymptomatic presentation suggested that these incidental tumours may not be clinically significant. However one of the patients who was diagnosed only 8 years after initial CEA elevation, showed on followup, persistent elevation of Calcitonin (which doubled within 24 months). Lymph node recurrence was noted. After a second surgery, her Calcitonin remained above 400 ng/L. Four other patients had persistently elevated Calcitonin post-operation. Only 4 had normalisation of Calcitonin levels on follow-up (2 to 10 years). The 10 patients appeared to have innocuous presentation initially but on follow up had a variable outcome. Some may have significant longterm disease.