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Medullary thyroid carcinoma — SCE Endocrinology MCQ

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HardThyroidMedullary thyroid carcinomaSCE Endocrinology

A 44-year-old man has flushing, diarrhoea and a thyroid nodule. Calcitonin is 1800 ng/L, CEA is elevated and calcium is 2.68 mmol/L. His father had adrenal surgery in his forties. What is the most appropriate next investigation?

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Correct answer: C — RET germline testing and plasma metanephrines

Medullary thyroid cancer with possible MEN2 requires RET germline testing and phaeochromocytoma exclusion before thyroid surgery. Thyroglobulin is a marker for differentiated thyroid cancer, not medullary disease. The pearl is to rule out phaeochromocytoma before operating in suspected MEN2.

Reference: NICE NG230, American Thyroid Association medullary thyroid carcinoma guideline