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Medullary thyroid carcinoma

From diagnosis to treatment
PhD ceremony:Mr H.H.G. (Hans) Verbeek
When:January 07, 2015
Supervisors:prof. dr. T.P. Links, J.T.M. (John) Plukker, prof. R.M.W. Hofstra
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Medullary thyroid carcinoma

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor, originating from the calcitonin producing C-cells in the thyroid. This thesis covers important clinical problems encountered in the diagnosis and treatment of primary and recurrent MTC.

Controversy exists about calcitonin screening in patients with thyroid nodules. We addressed the routine use of the calcitonin test in a formal meta-analysis. Although the sensitivity and specificity of the calcitonin test were high, a large number of patients with a positive test do not have MTC due to the low prevalence. This limits the use of routine calcitonin testing in patients with thyroid nodules.

Surgical treatment for MTC is crucial because no adjuvant treatment is available. We evaluated the current guidelines with respect to clinical outcome. Treatment according to guidelines improves biochemical cure and leads to fewer cancer reoperations. Referral centers treated patients more often according to these guidelines.

Early detection of patients with recurrent MTC is important because appropriate therapeutic interventions may delay further deterioration. We assessed two functional imaging methods, 18F-FDG PET and 18F-DOPA PET, for detecting recurrent disease in MTC. While 18F-FDG PET is superior in detecting progressive disease, 18F-DOPA PET can more accurately assess the extent of disease.

For the systemic treatment of recurrent MTC, tyrosine kinase inhibitors are currently available. As MTC can be caused by different mutations, we evaluated if there is specificity for different tyrosine kinase inhibitors. Specificity of the TK inhibitors for different mutations exists, suggesting that mutation-specific therapies might be of benefit for MTC patients.