Ukrani Janta, Barnes Martin, Ashraf Aqsa, Haggerty Gregory, Dacosta Noshir
Internal Medicine, Mather Hospital Northwell Health, Port Jefferson, USA.
Hematology and Oncology, Mather Hospital Northwell Health, Port Jefferson, USA.
Cureus. 2023 Jun 12;15(6):e40290. doi: 10.7759/cureus.40290. eCollection 2023 Jun.
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor. However, non-elevated calcitonin levels have been reported in the literature. We present the case of an 81-year-old woman with chronic elevations in carcinoembryonic antigen (CEA) levels for the past 15 years, despite normal calcitonin levels, who was ultimately diagnosed with MTC. The patient had a remote history of breast cancer and presented with symptoms of unintentional weight loss, fatigue, and joint pain. A positron emission tomography (PET) scan revealed low fluorodeoxyglucose (FDG) uptake in partially calcified thyroid nodules, and fine needle aspiration cytology was consistent with medullary carcinoma. The patient underwent total thyroidectomy, with pathology revealing a pT1aN0M0 medullary thyroid microcarcinoma with negative margins. After thyroidectomy, CEA levels decreased to within the normal range, and calcitonin levels remained normal. This case highlights the importance of considering MTC in patients with unexplained chronic elevations in CEA levels, even with normal calcitonin levels.
甲状腺髓样癌（MTC）是一种罕见的神经内分泌肿瘤。然而，文献中曾报道过降钙素水平未升高的情况。我们报告一例81岁女性病例，该患者在过去15年中癌胚抗原（CEA）水平持续慢性升高，尽管降钙素水平正常，但最终被诊断为MTC。患者有乳腺癌病史，表现为非刻意体重减轻、疲劳和关节疼痛。正电子发射断层扫描（PET）显示部分钙化的甲状腺结节中氟脱氧葡萄糖（FDG）摄取较低，细针穿刺细胞学检查结果与髓样癌一致。患者接受了甲状腺全切术，病理显示为pT1aN0M0甲状腺髓样微小癌，切缘阴性。甲状腺切除术后，CEA水平降至正常范围，降钙素水平仍保持正常。该病例强调了即使降钙素水平正常，对于CEA水平不明原因慢性升高的患者也应考虑MTC的重要性。
