Medüller Tiroid Kanseri
Özet
Medüller tiroid kanseri(MTK); parafoliküler veya C hücrelerinden köken alan tiroid bezinin nöroendokrin tümörüdür. MTK’li hastaların çoğu tanı anında metastatiktir. Multipl endokrin neoplazi tip 2(MEN 2) sendromunun bir bileşeni olarak %25’i aileseldir. Kalsitonin ve karsinoembrionik antijen (CEA) tümör belirteçleridir. Tedavi seçenekleri arasında cerrahi, radyoterapi ve lokal ablatif müdahaleler, kemoterapi, tirozin kinaz inhibitörleri, immünoterapi bulunmaktadır.
Medullary thyroid cancer (MTK); It is a neuroendocrine tumor of the thyroid gland originating from parafollicular or C cells. Most patients with MTC are metastatic at diagnosis. As a component of multiple endocrine neoplasia type 2 (MEN 2) syndrome, 25% are familial. Calcitonin and carcinoembryonic antigen (CEA) are tumor markers. Treatment options include surgery, radiotherapy and local ablative interventions, chemotherapy, tyrosine kinase inhibitors, immunotherapy.
Referanslar
Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, vd. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma. Thyroid [Internet]. Haziran 2015;25(6):567–610. Available at: https://www.liebertpub.com/doi/10.1089/thy.2014.0335
Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill CS, Hickey RC, vd. Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) [Internet]. Kasım 1984;63(6):319–42. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6503683
Dottorini ME, Assi A, Sironi M, Sangalli G, Spreafico G, Colombo L. Multivariate analysis of patients with medullary thyroid carcinoma. Prognostic significance and impact on treatment of clinical and pathologic variables. Cancer [Internet]. 15 Nisan 1996;77(8):1556–65. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8608543
Gagel RF, Hoff AO, Cote GJ. Medullary thyroid carcinoma. In: Werner & Ingbar’s The Thyroid, 9th, Braverman LE, Utiger RD (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.967.
Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer [Internet]. 01 Mart 2000;88(5):1139–48. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10699905
Pacini F, Castagna MG, Cipri C, Schlumberger M. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol) [Internet]. Ağustos 2010;22(6):475–85. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20627492
Machens A, Hauptmann S, Dralle H. Increased risk of lymph node metastasis in multifocal hereditary and sporadic medullary thyroid cancer. World J Surg [Internet]. Ekim 2007;31(10):1960–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17665245
Scheuba C, Kaserer K, Bieglmayer C, Asari R, Riss P, Drosten R, vd. Medullary thyroid microcarcinoma recommendations for treatment - a single-center experience. Surgery [Internet]. Aralık 2007;142(6):1003–10; discussion 1010.e1-3. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18063088
Machens A, Dralle H. Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening. Eur J Endocrinol 2016; 175:219.
Kwon H, Kim WG, Sung T-Y, Jeon MJ, Song DE, Lee Y-M, vd. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol [Internet]. Şubat 2016;113(2):152–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26799259
Machens A, Ukkat J, Hauptmann S, Dralle H. Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis. Arch Surg 2007; 142:289.
Busnardo B, Girelli ME, Simioni N, et al. Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma. Cancer 1984; 53:278.
Trimboli P, Nasrollah N, Amendola S, et al. Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer? Endocr J 2012; 59:503.
Choi N, Moon WJ, Lee JH, et al. Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 2011; 52:312.
Lee S, Shin JH, Han BK, Ko EY. Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. AJR Am J Roentgenol 2010; 194:1090.
Kim SH, Kim BS, Jung SL, et al. Ultrasonographic findings of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Korean J Radiol 2009; 10:101.
Bugalho MJ, Santos JR, Sobrinho L. Preoperative diagnosis of medullary thyroid carcinoma: fine needle aspiration cytology as compared with serum calcitonin measurement. J Surg Oncol 2005; 91:56.
Bhanot P, Yang J, Schnadig VJ, Logroño R. Role of FNA cytology and immunochemistry in the diagnosis and management of medullary thyroid carcinoma: report of six cases and review of the literature. Diagn Cytopathol 2007; 35:285.
Nikiforova MN, Mercurio S, Wald AI, et al. Analytical performance of the ThyroSeq v3 genomic classifier for cancer diagnosis in thyroid nodules. Cancer 2018; 124:1682.
Kudo T, Miyauchi A, Ito Y, et al. Diagnosis of medullary thyroid carcinoma by calcitonin measurement in fine-needle aspiration biopsy specimens. Thyroid 2007; 17:635.
Costante G, Filetti S. Early diagnosis of medullary thyroid carcinoma: is systematic calcitonin screening appropriate in patients with nodular thyroid disease? Oncologist 2011; 16:49.
Toledo SP, Lourenço DM Jr, Santos MA, et al. Hypercalcitoninemia is not pathognomonic of medullary thyroid carcinoma. Clinics (Sao Paulo) 2009; 64:699.
Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med 2005; 142:926.
Erdogan MF, Gursoy A, Kulaksizoglu M. Long-term effects of elevated gastrin levels on calcitonin secretion. J Endocrinol Invest 2006; 29:771.
Preissner CM, Dodge LA, O’Kane DJ, et al. Prevalence of heterophilic antibody interference in eight automated tumor marker immunoassays. Clin Chem 2005; 51:208.
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on August 20, 2012).
Machens A, Hauptmann S, Dralle H. Medullary thyroid cancer responsiveness to pentagastrin stimulation: an early surrogate parameter of tumor dissemination? J Clin Endocrinol Metab 2008; 93:2234.
Cohen R, Campos JM, Salaün C, et al. Preoperative calcitonin levels are predictive of tumor size and postoperative calcitonin normalization in medullary thyroid carcinoma. Groupe d’Etudes des Tumeurs a Calcitonine (GETC). J Clin Endocrinol Metab 2000; 85:
Machens A, Schneyer U, Holzhausen HJ, Dralle H. Prospects of remission in medullary thyroid carcinoma according to basal calcitonin level. J Clin Endocrinol Metab 2005; 90:2029.
Barbet J, Campion L, Kraeber-Bodéré F, et al. Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma. J Clin Endocrinol Metab 2005; 90:6077.
Laure Giraudet A, Al Ghulzan A, Aupérin A, et al. Progression of medullary thyroid carcinoma: assessment with calcitonin and carcinoembryonic antigen doubling times. Eur J Endocrinol 2008; 158:239.
Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab 2010; 95:2655.
Mirallié E, Vuillez JP, Bardet S, et al. High frequency of bone/bone marrow involvement in advanced medullary thyroid cancer. J Clin Endocrinol Metab 2005; 90:779.
Oudoux A, Salaun PY, Bournaud C, et al. Sensitivity and prognostic value of positron emission tomography with F-18-fluorodeoxyglucose and sensitivity of immunoscintigraphy in patients with medullary thyroid carcinoma treated with anticarcinoembryonic anti.
Giraudet AL, Vanel D, Leboulleux S, et al. Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metab 2007; 92:4185.
Ong SC, Schöder H, Patel SG, et al. Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels. J Nucl Med 2007; 48:501.
Asa S, Sonmezoglu K, Uslu-Besli L, et al. Evaluation of F-18 DOPA PET/CT in the detection of recurrent or metastatic medullary thyroid carcinoma: comparison with GA-68 DOTA-TATE PET/CT. Ann Nucl Med 2021; 35:900.
Moline J, Eng C. Multiple endocrine neoplasia type 2: an overview. Genet Med 2011; 13:755.
Eng C, Mulligan LM, Smith DP, et al. Low frequency of germline mutations in the RET proto-oncogene in patients with apparently sporadic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 1995; 43:123.
Zedenius J, Wallin G, Hamberger B, et al. Somatic and MEN 2A de novo mutations identified in the RET proto-oncogene by screening of sporadic MTC:s. Hum Mol Genet 1994; 3:1259.
Wohllk N, Cote GJ, Bugalho MM, et al. Relevance of RET proto-oncogene mutations in sporadic medullary thyroid carcinoma. J Clin Endocrinol Metab 1996; 81:3740.
Decker RA, Peacock ML, Borst MJ, et al. Progress in genetic screening of multiple endocrine neoplasia type 2A: is calcitonin testing obsolete? Surgery 1995; 118:257.
Elisei R, Romei C, Cosci B, et al. RET genetic screening in patients with medullary thyroid cancer and their relatives: experience with 807 individuals at one center. J Clin Endocrinol Metab 2007; 92:4725.
Marsh DJ, Learoyd DL, Andrew SD, et al. Somatic mutations in the RET proto-oncogene in sporadic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 1996; 44:249.
Moura MM, Cavaco BM, Pinto AE, et al. Correlation of RET somatic mutations with clinicopathological features in sporadic medullary thyroid carcinomas. Br J Cancer 2009; 100:1777.
Moura MM, Cavaco BM, Pinto AE, Leite V. High prevalence of RAS mutations in RET-negative sporadic medullary thyroid carcinomas. J Clin Endocrinol Metab 2011; 96:E863.
Romei C, Elisei R, Pinchera A, et al. Somatic mutations of the ret protooncogene in sporadic medullary thyroid carcinoma are not restricted to exon 16 and are associated with tumor recurrence. J Clin Endocrinol Metab 1996; 81:1619.
Elisei R, Cosci B, Romei C, et al. Prognostic significance of somatic RET oncogene mutations in sporadic medullary thyroid cancer: a 10-year follow-up study. J Clin Endocrinol Metab 2008; 93:682.
Tuttle RM, Ganly I. Risk stratification in medullary thyroid cancer: moving beyond static anatomic staging. Oral Oncol 2013; 49:695.
Yang JH, Lindsey SC, Camacho CP, et al. Integration of a postoperative calcitonin measurement into an anatomical staging system improves initial risk stratification in medullary thyroid cancer. Clin Endocrinol (Oxf) 2015; 83:938.
Selpercatinib capsules. United States Prescribing Information. US National Library of Medicine. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213246s000lbl.pdf (Accessed on May 11, 2020).
Wirth LJ, Sherman E, Robinson B, et al. Efficacy of Selpercatinib in RET-Altered Thyroid Cancers. N Engl J Med 2020; 383:825.
Genetech provides update on Gavreto U.S. indication for advanced or metastatic medullary thyroid cancer. Genetech. June 29, 2023. Available at: https://www.gene.com/media/statements/ps_062923 (Accessed on July 12, 2023).
Ball DW. Medullary thyroid cancer: monitoring and therapy. Endocrinol Metab Clin North Am 2007; 36:823.
Referanslar
Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, vd. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma. Thyroid [Internet]. Haziran 2015;25(6):567–610. Available at: https://www.liebertpub.com/doi/10.1089/thy.2014.0335
Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill CS, Hickey RC, vd. Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) [Internet]. Kasım 1984;63(6):319–42. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6503683
Dottorini ME, Assi A, Sironi M, Sangalli G, Spreafico G, Colombo L. Multivariate analysis of patients with medullary thyroid carcinoma. Prognostic significance and impact on treatment of clinical and pathologic variables. Cancer [Internet]. 15 Nisan 1996;77(8):1556–65. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8608543
Gagel RF, Hoff AO, Cote GJ. Medullary thyroid carcinoma. In: Werner & Ingbar’s The Thyroid, 9th, Braverman LE, Utiger RD (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.967.
Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer [Internet]. 01 Mart 2000;88(5):1139–48. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10699905
Pacini F, Castagna MG, Cipri C, Schlumberger M. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol) [Internet]. Ağustos 2010;22(6):475–85. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20627492
Machens A, Hauptmann S, Dralle H. Increased risk of lymph node metastasis in multifocal hereditary and sporadic medullary thyroid cancer. World J Surg [Internet]. Ekim 2007;31(10):1960–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17665245
Scheuba C, Kaserer K, Bieglmayer C, Asari R, Riss P, Drosten R, vd. Medullary thyroid microcarcinoma recommendations for treatment - a single-center experience. Surgery [Internet]. Aralık 2007;142(6):1003–10; discussion 1010.e1-3. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18063088
Machens A, Dralle H. Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening. Eur J Endocrinol 2016; 175:219.
Kwon H, Kim WG, Sung T-Y, Jeon MJ, Song DE, Lee Y-M, vd. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol [Internet]. Şubat 2016;113(2):152–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26799259
Machens A, Ukkat J, Hauptmann S, Dralle H. Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis. Arch Surg 2007; 142:289.
Busnardo B, Girelli ME, Simioni N, et al. Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma. Cancer 1984; 53:278.
Trimboli P, Nasrollah N, Amendola S, et al. Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer? Endocr J 2012; 59:503.
Choi N, Moon WJ, Lee JH, et al. Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 2011; 52:312.
Lee S, Shin JH, Han BK, Ko EY. Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. AJR Am J Roentgenol 2010; 194:1090.
Kim SH, Kim BS, Jung SL, et al. Ultrasonographic findings of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Korean J Radiol 2009; 10:101.
Bugalho MJ, Santos JR, Sobrinho L. Preoperative diagnosis of medullary thyroid carcinoma: fine needle aspiration cytology as compared with serum calcitonin measurement. J Surg Oncol 2005; 91:56.
Bhanot P, Yang J, Schnadig VJ, Logroño R. Role of FNA cytology and immunochemistry in the diagnosis and management of medullary thyroid carcinoma: report of six cases and review of the literature. Diagn Cytopathol 2007; 35:285.
Nikiforova MN, Mercurio S, Wald AI, et al. Analytical performance of the ThyroSeq v3 genomic classifier for cancer diagnosis in thyroid nodules. Cancer 2018; 124:1682.
Kudo T, Miyauchi A, Ito Y, et al. Diagnosis of medullary thyroid carcinoma by calcitonin measurement in fine-needle aspiration biopsy specimens. Thyroid 2007; 17:635.
Costante G, Filetti S. Early diagnosis of medullary thyroid carcinoma: is systematic calcitonin screening appropriate in patients with nodular thyroid disease? Oncologist 2011; 16:49.
Toledo SP, Lourenço DM Jr, Santos MA, et al. Hypercalcitoninemia is not pathognomonic of medullary thyroid carcinoma. Clinics (Sao Paulo) 2009; 64:699.
Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med 2005; 142:926.
Erdogan MF, Gursoy A, Kulaksizoglu M. Long-term effects of elevated gastrin levels on calcitonin secretion. J Endocrinol Invest 2006; 29:771.
Preissner CM, Dodge LA, O’Kane DJ, et al. Prevalence of heterophilic antibody interference in eight automated tumor marker immunoassays. Clin Chem 2005; 51:208.
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on August 20, 2012).
Machens A, Hauptmann S, Dralle H. Medullary thyroid cancer responsiveness to pentagastrin stimulation: an early surrogate parameter of tumor dissemination? J Clin Endocrinol Metab 2008; 93:2234.
Cohen R, Campos JM, Salaün C, et al. Preoperative calcitonin levels are predictive of tumor size and postoperative calcitonin normalization in medullary thyroid carcinoma. Groupe d’Etudes des Tumeurs a Calcitonine (GETC). J Clin Endocrinol Metab 2000; 85:
Machens A, Schneyer U, Holzhausen HJ, Dralle H. Prospects of remission in medullary thyroid carcinoma according to basal calcitonin level. J Clin Endocrinol Metab 2005; 90:2029.
Barbet J, Campion L, Kraeber-Bodéré F, et al. Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma. J Clin Endocrinol Metab 2005; 90:6077.
Laure Giraudet A, Al Ghulzan A, Aupérin A, et al. Progression of medullary thyroid carcinoma: assessment with calcitonin and carcinoembryonic antigen doubling times. Eur J Endocrinol 2008; 158:239.
Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab 2010; 95:2655.
Mirallié E, Vuillez JP, Bardet S, et al. High frequency of bone/bone marrow involvement in advanced medullary thyroid cancer. J Clin Endocrinol Metab 2005; 90:779.
Oudoux A, Salaun PY, Bournaud C, et al. Sensitivity and prognostic value of positron emission tomography with F-18-fluorodeoxyglucose and sensitivity of immunoscintigraphy in patients with medullary thyroid carcinoma treated with anticarcinoembryonic anti.
Giraudet AL, Vanel D, Leboulleux S, et al. Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metab 2007; 92:4185.
Ong SC, Schöder H, Patel SG, et al. Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels. J Nucl Med 2007; 48:501.
Asa S, Sonmezoglu K, Uslu-Besli L, et al. Evaluation of F-18 DOPA PET/CT in the detection of recurrent or metastatic medullary thyroid carcinoma: comparison with GA-68 DOTA-TATE PET/CT. Ann Nucl Med 2021; 35:900.
Moline J, Eng C. Multiple endocrine neoplasia type 2: an overview. Genet Med 2011; 13:755.
Eng C, Mulligan LM, Smith DP, et al. Low frequency of germline mutations in the RET proto-oncogene in patients with apparently sporadic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 1995; 43:123.
Zedenius J, Wallin G, Hamberger B, et al. Somatic and MEN 2A de novo mutations identified in the RET proto-oncogene by screening of sporadic MTC:s. Hum Mol Genet 1994; 3:1259.
Wohllk N, Cote GJ, Bugalho MM, et al. Relevance of RET proto-oncogene mutations in sporadic medullary thyroid carcinoma. J Clin Endocrinol Metab 1996; 81:3740.
Decker RA, Peacock ML, Borst MJ, et al. Progress in genetic screening of multiple endocrine neoplasia type 2A: is calcitonin testing obsolete? Surgery 1995; 118:257.
Elisei R, Romei C, Cosci B, et al. RET genetic screening in patients with medullary thyroid cancer and their relatives: experience with 807 individuals at one center. J Clin Endocrinol Metab 2007; 92:4725.
Marsh DJ, Learoyd DL, Andrew SD, et al. Somatic mutations in the RET proto-oncogene in sporadic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 1996; 44:249.
Moura MM, Cavaco BM, Pinto AE, et al. Correlation of RET somatic mutations with clinicopathological features in sporadic medullary thyroid carcinomas. Br J Cancer 2009; 100:1777.
Moura MM, Cavaco BM, Pinto AE, Leite V. High prevalence of RAS mutations in RET-negative sporadic medullary thyroid carcinomas. J Clin Endocrinol Metab 2011; 96:E863.
Romei C, Elisei R, Pinchera A, et al. Somatic mutations of the ret protooncogene in sporadic medullary thyroid carcinoma are not restricted to exon 16 and are associated with tumor recurrence. J Clin Endocrinol Metab 1996; 81:1619.
Elisei R, Cosci B, Romei C, et al. Prognostic significance of somatic RET oncogene mutations in sporadic medullary thyroid cancer: a 10-year follow-up study. J Clin Endocrinol Metab 2008; 93:682.
Tuttle RM, Ganly I. Risk stratification in medullary thyroid cancer: moving beyond static anatomic staging. Oral Oncol 2013; 49:695.
Yang JH, Lindsey SC, Camacho CP, et al. Integration of a postoperative calcitonin measurement into an anatomical staging system improves initial risk stratification in medullary thyroid cancer. Clin Endocrinol (Oxf) 2015; 83:938.
Selpercatinib capsules. United States Prescribing Information. US National Library of Medicine. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213246s000lbl.pdf (Accessed on May 11, 2020).
Wirth LJ, Sherman E, Robinson B, et al. Efficacy of Selpercatinib in RET-Altered Thyroid Cancers. N Engl J Med 2020; 383:825.
Genetech provides update on Gavreto U.S. indication for advanced or metastatic medullary thyroid cancer. Genetech. June 29, 2023. Available at: https://www.gene.com/media/statements/ps_062923 (Accessed on July 12, 2023).
Ball DW. Medullary thyroid cancer: monitoring and therapy. Endocrinol Metab Clin North Am 2007; 36:823.