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Invited Critique
March 1, 2007

Abnormal Carcinoembryonic Antigen Levels and Medullary Thyroid Cancer Progression—Invited Critique

Arch Surg. 2007;142(3):294. doi:10.1001/archsurg.142.3.294

The tumor biology and clinical behavior of medullary thyroid cancer are different from those of differentiated thyroid cancer. Medullary thyroid cancer is more aggressive. It is multicentric and bilateral in 90% of patients with familial disease and multicentric in 20% of patients with sporadic disease. It is associated with lymph node metastases in more than 50% of patients. Medullary thyroid cancer does not take up radioactive iodine and does not respond to thyrotropin suppression.1,2 Surgery is the only effective therapeutic modality. At minimum, treatment should consist of total thyroidectomy and a central neck dissection, which entails removal of all lymph nodes and fibrofatty tissue between the right and left common carotid arteries from the hyoid bone superiorly to the innominate vein inferiorly. Controversy exists over whether a routine ipsilateral or a bilateral modified neck dissection should also be performed.1,2

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