Medullary thyroid cancer natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

If left untreated, patients with medullary thyroid cancer may progress to develop metastasis. Common complications of medullary thyroid cancer include vocal cord compression, dysphagia, and dyspnea. The presence of metastasis is associated with a particularly poor prognosis among patients with medullary thyroid cancer. The 5-year event-free survival rate is 80%.

• The symptoms of sporadic medullary thyroid cancer usually develop in the fifth and sixth decade of life and start with a nodule in the upper lobe of the thyroid.^[1]
• In 50% of the patients, the initial presentation may be metastatic cervical adenopathy.
• Symptoms of adjacent structures compression or invasion may manifest in 15% of the patients.
• Without treatment, the patient will develop symptoms of metastasis such as to lungs and/or bones, which may eventually lead to death.

• Possible complications of medullary thyroid cancer include:
  • Metastases to lung, bones, liver, and brain^[1]
  • Hypocalcemia after surgery due to parathyroid removal
  • Dysphagia
  • Hoarseness
  • Diarrhea
  • Cushing’s syndrome

• Medullary thyroid cancer prognosis depends on the stage of the disease at the time of diagnosis.^[2][3]
• The 5-year relative survival rate is 93% for stage I to III.
• The 5-year survival rate for stage IV is 28%.
• Medullary thyroid cancer is associated with a 5-year survival rate of 86% and 10-year survival rate of 65%.

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