Medullary carcinoma of the thyroid arises from the parafollicular C cells (the cell of origin of calcitonin), and may be sporadic or familial. If the latter, it may or may not be part of the MEN syndrome, and the diagnosing clinician should take a family history and screen for phaeochromocytoma. Surgical clearance of apparently localized disease to the neck is the only curative hope and is the first therapeutic step. For recurrent disease (for which the serum calcitonin serves as a good marker), occasional avidity of uptake to meta-iodo-benzyl-guanadine (MIBG) makes radioiodinated MIBG therapy a possibly useful therapeutic modality. Otherwise there is no useful therapy except for palliative radiotherapy where appropriate; we have had little to no success with palliative chemotherapy.
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