Prophylactic thyroidectomy as method of medullary thyroid carcinoma prevention in children from MEN syndrom families

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Abstract


The article presents results of diagnostics, surgical treatment and follow-up of patients with rare hereditary-conditioned forms of thyroid cancer – medullary thyroid carcinoma in content of multiple endocrine neoplasia syndrome. Particular attention is paid to the examination and tactics of treatment of children and adolescents with family genetically confirmed Sipple syndrome. The disease is diagnosed in 4 families. Syndrome of multiple endocrine neoplasia 2a type we found in 7 (0.024%) of 29,325 children and adult patients. All the children were from families in which one of the blood relatives suffered medullary thyroid cancer. The family nature of the disease was confirmed by molecular genetic studies that revealed mutations in C634 (T1900C) in the 11 exon of the RET gene. Only in 3 out of 7 cases thyroidectomy was prophylactic. Four children were fond foci of medullary carcinoma in the removed thyroid gland. In total, 22 operations were performed for the members of 4 families suffering from the family syndrome MEN-2a. The article shows that if a patient is diagnosed Sippl's syndrome, all his blood relatives need to be checked for the mutation of the RET gene to identify familial medullary thyroid cancer, adenomas of parathyroid glands and pheochromocytomas. Early removal of the thyroid gland (in children under the age of 5 years) prevents medullary cancer, and timely diagnosis and adequate surgical removal of neoplasms of parathyroid glands and adrenal glands ensure recovery of the patients. Closest relatives should be checked for the level of calcium and calcitonin, catecholamines, vanillylmandelic acid and metanephrine, ACTH, cancer-embryonic antigen.


Zoya S. Matveeva

Author for correspondence.
ikar122@list.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Assistant Professor, Department of Hospital Surgery with Traumatology and Military Surgery Courses

Anatoliy F. Romanchishen

afromanchishen@mail.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Dr Med Sci, Professor, Head, Department of Hospital Surgery with Traumatology and Military Surgery Courses

Alexandr V. Gostimsky

gostimsky@mail.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Dr Med Sci, Professor, Head, Department of General Medical Practice

Kristina V. Vabalayte

vabalayte@bk.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Associate Professor, Department of Hospital Surgery with Traumatology and Military Surgery Courses

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Copyright (c) 2017 Matveeva Z.S., Romanchishen A.F., Gostimsky A.V., Vabalayte K.V.

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