American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2016, 4(1), 8-11
DOI: 10.12691/ajmcr-4-1-3
Open AccessCase Report

A Rare Presentation of Medullary Carcinoma Thyroid

Balakrishnan valliyot1, Saroshkumar KK1, Sarin SM1, Kadeeja beevi B1, Nirmal mathew alex1, and Tency joshu thomas1

1Department of Medicine, ACME Pariyaram, Kannur, India

Pub. Date: January 08, 2016

Cite this paper:
Balakrishnan valliyot, Saroshkumar KK, Sarin SM, Kadeeja beevi B, Nirmal mathew alex and Tency joshu thomas. A Rare Presentation of Medullary Carcinoma Thyroid. American Journal of Medical Case Reports. 2016; 4(1):8-11. doi: 10.12691/ajmcr-4-1-3


Medullary Thyroid Carcinoma (MTC) is a rare thyroid tumor that arises from neural crest-derived Calcitonin producing Para follicular C cells and accounts for approximately 4 % of thyroid malignancies. This neuroendocrine tumor typically is an aggressive cancer, with secretion of several neuro-humoral mediators. We report a case of 49 year old male patient who presented with episodes of chest discomfort and abdominal pain associated with loud screaming of unknown etiology, on evaluation found to have Medullary Thyroid Carcinoma as its cause. MTC usually present as palpable firm to hard thyroid nodules or enlargement of regional lymph nodes. Since the systemic symptoms of MTC are nonspecific, it is challenging to diagnose MTC when patients first presents with systemic symptoms as in our patient. This case is reported to highlight the unusual presentation of this rare thyroid tumor and to emphasize the need for meticulous clinical examination and high index of suspicion to diagnose it.

medullary carcinoma thyroid thyroid malignancy neurohormones

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 6


[1]  Paul. A FitzGerald, CMDT 2015 endocrine disorders 1122.
[2]  Martin-Jeanschlumberger, Sebastianofiletti, Ian d. hay. Williams’s endocrinology 12th edition 2011; 14 475-477.
[3]  American Thyroid Association Guidelines Task Force, Kloos, R.T., Eng, C., Evans, D.B., Francis, G.L., Gagel, R.F., Gharib, H., Moley, J.F., Pacini, F., Ringel, M.D..
[4]  Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid cancer of the follicular epithelium. Eur J Endocrinol. 2006;154:787-803.
[5]  Schlumberger, M. & Wells, S.A. Jr. (2009). Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid, Vol.19(No.6):565-612.
[6]  Pacini, F., Castagna, M.G., Cipri, C. & Schlumberger, M. (2010). Medullary thyroidcarcinoma. Clinical Oncology, Vol. 22(No.6): 475-485.
[7]  Meijer, J.A., le Cessie, S., van den Hout, W.B., Kievit, J., Schoones, J.W., Romijn, J.A. &Smit, J.W. (2010). Calcitonin and carcinoembryonic antigen doubling times as prognostic factors in medullary thyroid carcinoma: a structured meta-analysis. Clinical Endocrinology, Vol.72(No.4):534-542.
[8]  vanVeelen, W., de Groot, J.W., Acton, D.S., Hofstra, R.M., Höppener, J.W., Links, T.P. &Lips, C.J. (2009). Medullary thyroid carcinoma and biomarkers: past, present and future. Journal of Internal Medicine, Vol.266(No.1):126-140.
[9]  Gourgiotis L, Sarlis NJ, Reynolds JC, et al. Localization of medullary thyroid carcinoma metastasis in a multiple endocrine neoplasia type 2A patient by 6-(F-18)-fluorodopamine positron emission tomography. J ClinEndocrinolMetab. 2003;88:637-641.
[10]  Nocera M, Baudin E, Pellegriti G, et al. Treatment of advanced medullary thyroid cancer with an alternating combination of doxorubicinstreptozocin and 5 FU-dacarbazine. Grouped’Étude des Tumeurs a Calcitonine (GETC). Br J Cancer. 2000;83:715-718.
[11]  Fromigué J, De Baere T, Baudin E, et al. Chemoembolization for liver metastases from medullary thyroid carcinoma. J ClinEndocrinolMetab. 2006;91:2496-2499.
[12]  Schlumberger M, Carlomagno F, Baudin E, et al. New therapeutic approaches for medullary thyroid carcinoma. Nat Clin Pract Endocrinol Metab. 2008; 4:22-32.
[13]  Wells S, Gosnell J, Gagel R, et al. Vandetanib for the treatment of patients with locally advanced or metastatic hereditary medullary thyroid cancer. J ClinOncol. 2009;28:767-772.
[14]  Xing M etal.progress in molecular based management of differentiated thyroid cancer. Lancet 2013 march 23; 381(9871) 1058-69.