Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1343-1352
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1343
Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance? A case report
Feng-Jiao Gan, Tie Zhou, Shun Wu, Meng-Xi Xu, Su-Hong Sun
Feng-Jiao Gan, Tie Zhou, Shun Wu, Meng-Xi Xu, Su-Hong Sun, Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Feng-Jiao Gan and Su-Hong Sun put forward the concept and wrote the reply to reviewers’ opinions; Feng-Jiao Gan verified the data, provided data resources, organized the data, and wrote the first draft; Tie Zhou and Shun Wu performed the experiments; Feng-Jiao Gan, Tie Zhou, Shun Wu, Meng-Xi Xu, and Su-Hong Sun supervised the study, managed the project, and obtained funding; all authors have read and approved the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 81860469; Zunyi Science and Technology Bureau, China, ZunShi KeHe HZ (2019) No. 85; Honghuagang District Science and Technology Bureau of Zunyi City, China, ZunHong KeHe Shezi (2018) No. 12.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: We have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Su-Hong Sun, MD, Professor, Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi 563000, Guizhou Province, China,
Received: August 13, 2020
Peer-review started: August 13, 2020
First decision: August 21, 2020
Revised: August 24, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: February 26, 2021

In clinical work, 85%-90% of malignant thyroid diseases are papillary thyroid cancer (PTC); thus, clinicians neglect other types of thyroid cancer, such as medullary thyroid carcinoma (MTC).


We report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL. There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology, but the presence of PTC and MTC was confirmed by postoperative paraffin pathology. The patient underwent total thyroidectomy and bilateral central lymph node dissection. Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.


The issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC. In the absence of central lymph node metastasis, it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.

Keywords: Medullary thyroid carcinoma, Papillary thyroid carcinoma, Simultaneous different types of thyroid cancer, Calcitonin, Fine needle aspiration cytology, Surgery, Case report

Core Tip: Medullary thyroid carcinoma accounts for a small proportion of all types of thyroid cancer and is rarely encountered clinically. Therefore, medullary thyroid carcinoma requires further study. For patients with medullary thyroid cancer and high calcitonin levels, it may be possible to choose a surgical approach with a small range of operations. By closely monitoring the trend of calcitonin changes and survival follow-up results for 1.5 years, we herein propose a new question about the surgical scope of medullary thyroid carcinoma: Do thyroid medullary carcinoma patients with high calcitonin require lateral neck lymphadenectomy?