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57

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

6

Treatment guide

Medullary thyroid cancer

Guide 19. Primary treatment for medullary

Disease status Primary treatment Next steps of care

1.0 cm or smaller

(diameter or

bilateral) thyroid

cancer

ª

• Total thyroidectomy

and central neck

dissection

• Consider lateral

neck dissection

(same side as

nodule or both

sides)

• Consider radiation

therapy (EBRT/

IMRT) for

incomplete surgery

(when additional

surgery is not an

option) or after

surgery (adjuvant

therapy - rarely

recommended)

• Levothyroxine

(after surgery) to

normalize TSH

ª

• Care 2 to 3 months after

surgery (See Guide 21)

Smaller than 1.0

cm (diameter and

unilateral) thyroid

cancer

ª

Total thyroidectomy

and consider neck

dissection

ª

• Care 2 to 3 months after

surgery (See Guide 21)

Medullary

diagnosed after

initial thyroid

surgery

ª

• RET positive

ª

• See primary treatment in

Guide 20

• RET negative

ª

• Care 2 to 3 months after

surgery (See Guide 21)

Guides 19 and 20

discuss primary treatment

options for medullary thyroid cancer. They are

separated to show the options for disease that does

not run in families and when it does run in families

(inherited).

For medullary thyroid cancer that is not inherited,

treatment may involve surgery with possible neck

dissection, radiation therapy, and levothyroxine.

See Guide 19.

Treatment depends on the size of

disease. If you have molecular testing before surgery

and it shows that you inherited a RET mutation, see

the primary treatment options for inherited medullary

thyroid cancer in guide 20.