Overview
Differentiated Thyroid Cancers (DTC) include Papillary Thyroid Cancer (PTC) and Follicular
Thyroid Cancer (FTC). Together, they account for over 90 percent of thyroid cancers. These
cancers arise from thyroid follicular cells and are known for their excellent prognosis, slow
growth, and high cure rates when treated appropriately.
PTC is the most common and often affects younger individuals, especially women. FTC is
slightly less common but more likely to spread through the bloodstream. With modern
diagnostics, risk stratification, precision surgery, radioiodine therapy, and long-term surveillance,
DTC has one of the highest survival rates of all solid tumors.
At Coimbatore Cancer Clinic, our surgical and medical oncologists provide complete,
evidence-based care—including thyroid ultrasound, FNAC, expert thyroid surgery, radioactive
iodine (RAI) coordination, targeted therapies for advanced disease, and lifelong
follow-up—based on NCCN/ATA 2025 guidelines
Types of Differentiated Thyroid Cancer
1. Papillary Thyroid Carcinoma (PTC)
● Most common (80–85 percent)
● Often spreads to lymph nodes
● Excellent prognosis
Variants include:
● Classical PTC
● Follicular variant
● Tall-cell variant
● Hobnail/sclerosing variants (higher risk)
2. Follicular Thyroid Carcinoma (FTC)
● Accounts for 10–15 percent
● Tends to spread via bloodstream to lungs/bones
● Hurthle cell carcinoma is considered a separate variant
Causes & Risk Factors
1. Radiation Exposure
Childhood neck radiation significantly increases risk.
2. Family History / Genetic Syndromes
● Familial non-medullary thyroid cancer
● Cowden syndrome
● FAP (rare)
3. Iodine Imbalance
Low iodine intake associated with follicular carcinoma.
4. Female Gender
Women are 3–4 times more likely to develop DTC
5. Thyroid Nodules
Most are benign; some progress to cancer
Symptoms & Warning Signs
Most thyroid cancers are asymptomatic and discovered incidentally.
Common Symptoms
● Neck swelling or thyroid nodule
● Difficulty swallowing
● Persistent hoarseness
● Neck discomfort
● Enlarged neck lymph nodes
Advanced Symptoms
● Breathing difficulty
● Cough
● Bone pain (if distant metastasis in FTC)
Any persistent thyroid lump should be evaluated.
Diagnostic Evaluation
1. Thyroid Ultrasound
Gold standard for:
● Nodule characterization
● Lymph node evaluation
● Risk scoring (TI-RADS)
2. Fine-Needle Aspiration Cytology (FNAC)
Determines if the nodule is benign, suspicious, or malignant.
3. Molecular Testing (if FNAC is indeterminate)
● BRAF mutation
● RAS mutation
● RET/PTC & PAX8-PPARγ rearrangements
Helps guide need for surgery.
4. Thyroid Function Tests
Most thyroid cancers occur with normal thyroid hormone levels.
5. Imaging for Advanced Disease
● CT neck/chest for bulky nodes
● MRI if trachea/esophagus involved
● Bone scan or PET-CT for FTC with distant metastasis
Staging (AJCC 8th Edition)
Thyroid cancer staging includes:
● Tumor size
● Lymph node involvement
● Spread beyond thyroid
● Distant metastasis
Age cut-off for staging is 55 years (special rule in thyroid cancer).
Treatment – Stage-wise (NCCN/ATA 2025)
The cornerstone of treatment is surgery, followed by selective use of radioactive iodine (RAI)
and thyroid hormone suppression.
Surgery – Primary Treatment
Surgery type depends on tumor size, risk factors, and imaging.
1. Total Thyroidectomy
Recommended for:
● Tumors >4 cm
● Multifocal disease
● Extrathyroidal extension
● Lymph node spread
● High-risk variants
● FTC
2. Hemithyroidectomy (Lobectomy)
Recommended for:
● Single nodule <4 cm
● No extrathyroidal extension
● No lymph node involvement
● Low-risk PTC
Provides excellent outcomes with fewer complications.
3. Central Neck Dissection
Performed for:
● Confirmed lymph node metastasis
● High-risk tumors
4. Lateral Neck Dissection
For confirmed spread to lateral lymph nodes.
5. Nerve & Parathyroid Preservation
Expertise in preserving:
● Recurrent laryngeal nerve
● Parathyroid glands
Preventing hoarseness and hypocalcemia.
Radioactive Iodine Therapy (RAI)
Indications
● Intermediate/high-risk tumors
● Lymph node metastasis
● Tumors >4 cm
● Extrathyroidal extension
● Distant metastasis (especially FTC)
Mechanism
RAI destroys residual thyroid tissue or microscopic cancer cells.
Preparation for RAI
● Thyroid hormone withdrawal OR
● Recombinant TSH (rhTSH) stimulation
Side Effects
● Dry mouth
● Altered taste
● Neck tenderness
Thyroid Hormone Suppression Therapy
After surgery, patients receive levothyroxine to:
● Replace hormones
● Suppress TSH (a growth stimulus for thyroid cancer cells)
TSH target depends on risk category
External Beam Radiation Therapy
Used rarely, in:
● Unresectable tumors
● Recurrent disease
● Non-RAI–avid disease
Delivered as IMRT.
Targeted Therapy & Immunotherapy
For advanced, RAI-refractory disease.
1. Targeted Therapy (TKIs)
● Lenvatinib (first-line)
● Sorafenib
● Cabozantinib (second-line)
2. Genetic Targeted Therapy
● RET inhibitors (selpercatinib, pralsetinib)
● NTRK inhibitors (larotrectinib, entrectinib)
Highly effective in mutation-positive cancers.
3. Immunotherapy
Checkpoint inhibitors (pembrolizumab) for selected cases.
Follow-Up & Surveillance
Regular monitoring is essential to detect recurrence early.
Includes
● Serum thyroglobulin (Tg) – tumor marker
● Anti-thyroglobulin antibody levels
● Neck ultrasound
● Periodic whole-body scans if needed
Follow-Up Frequency
● Every 6–12 months initially
● Lifelong surveillance for FTC and high-risk PTC
Prognosis
Differentiated thyroid cancer has excellent survival.
10-year survival rates
● PTC: >95 percent
● FTC: 85–90 percent
Better outcomes in:
● Younger patients
● Small tumors
● Early-stage disease
Special Considerations
Papillary Thyroid Microcarcinoma (<1 cm)
May be monitored with active surveillance in selected patients.
Pregnancy
Thyroid surgery and surveillance are safe with proper planning.
Children
PTC is common but has excellent outcomes.
Our Expertise at Coimbatore Cancer Clinic
● High-quality ultrasound and FNAC interpretation
● Expertise in thyroidectomy with nerve & parathyroid preservation
● Central and lateral neck dissection by experienced surgeons
● RAI therapy coordination with nuclear medicine teams
● Molecular testing for targeted therapy
● Long-term survivorship care and recurrence monitoring
● Personalized risk-based treatment plans
We focus on safe surgery, excellent cosmetic outcomes, and long-term cure.
When to Consult
Consult us if you have:
● A thyroid nodule
● Neck swelling
● Hoarseness
● Difficulty swallowing
● Enlarged lymph nodes
● Family history of thyroid cancer
Early diagnosis ensures the best results.
Frequently Asked Questions (FAQs)
Disclaimer
This page provides general information for patient education. Treatment must be individualized
based on consultation with qualified surgical and medical oncologists.
Medullary Thyroid Carcinoma (MTC) –
Causes, Symptoms, Diagnosis, Treatment
& Latest Advances
Overview
Medullary Thyroid Carcinoma (MTC) is a rare thyroid cancer arising from the parafollicular
C-cells, which produce the hormone calcitonin. Unlike papillary and follicular thyroid cancer,
MTC does not originate from thyroid follicular cells and does not absorb radioactive
iodine—making its treatment and follow-up fundamentally different.
MTC occurs in two main forms:
1. Sporadic MTC (75 percent)
2. Hereditary MTC (25 percent), associated with MEN2A, MEN2B, and FMTC syndromes
caused by mutations in the RET proto-oncogene.
Early diagnosis and complete surgical removal offer the best chance of cure. Advanced MTC
may require targeted therapies that are highly effective in RET-mutated disease.
At Coimbatore Cancer Clinic, our surgical and medical oncologists deliver comprehensive,
evidence-based care including genetic testing, expert thyroid and neck surgery, targeted
systemic therapies, and long-term calcitonin-based surveillance following NCCN/ATA 2025
guidelines.
Types of Medullary Thyroid Carcinoma
1. Sporadic MTC
● Most common form
● Usually diagnosed in adulthood
● Often presents as a single tumor in the thyroid
2. Hereditary MTC
Caused by germline RET mutation. Often multifocal and bilateral.
Associated syndromes:
● MEN2A – MTC + pheochromocytoma + hyperparathyroidism
● MEN2B – aggressive MTC, mucosal neuromas, marfanoid habitus
● FMTC – familial MTC without other hormonal tumors
All first-degree relatives require genetic testing
Causes & Risk Factors
1. RET Gene Mutations (Most Important)
● Present in all hereditary MTC
● Also in 40–50 percent of sporadic MTC (somatic mutations)
2. Family History
Strong predictor of hereditary disease
3. Age & Gender
Hereditary cases occur at younger ages
4. Radiation Exposure
Not a major risk factor (unlike other thyroid cancers).
Symptoms & Warning Signs
Common Symptoms
● Thyroid nodule
● Neck swelling
● Hoarseness
● Difficulty swallowing
● Persistent cough
Symptoms of Hormonal Effects
● Diarrhea (due to high calcitonin)
● Flushing (due to hormone secretion)
Advanced Symptoms
● Neck lymph nodes
● Liver or lung metastases
● Bone pain
Diagnostic Evaluation
1. Thyroid Ultrasound
Assesses:
● Nodule characteristics
● Multifocal tumors
● Suspicious lymph nodes
2. FNAC (Fine Needle Aspiration Cytology)
Useful but may not always confirm MTC.
3. Serum Markers (Essential)
● Calcitonin – tumor marker
● CEA (Carcinoembryonic Antigen) – correlates with tumor burden
High calcitonin strongly suggests MTC.
4. Genetic Testing (RET Mutation Analysis)
Recommended for:
● All patients with confirmed MTC
● All first-degree relatives
5. MEN Screening
MEN2 evaluation includes:
● Plasma metanephrines (to rule out pheochromocytoma)
● Serum calcium & PTH (hyperparathyroidism)
6. Imaging
● Contrast CT neck
● Chest CT
● Liver MRI
● Bone scan or PET-CT for metastatic disease
Staging (AJCC 8th Edition)
Based on:
● Tumor size
● Extrathyroidal extension
● Lymph node spread
● Distant metastasis
Lymph node involvement is common even in early tumors
Treatment – Stage-wise (NCCN/ATA 2025)
Key Principle:
Surgery is the only curative treatment.
RAI is not effective because C-cells do not absorb iodine.
Surgery – Mainstay of Treatment
1. Total Thyroidectomy
Recommended for all MTC patients.
2. Central Neck Dissection (Level VI)
Performed routinely, as microscopic spread is common.
3. Lateral Neck Dissection
Indicated for:
● Clinically involved nodes
● High calcitonin (>200 pg/mL)
● Confirmed metastasis
4. Management of Hereditary MTC
Timing depends on RET mutation risk category:
● MEN2B (highest risk): surgery in infancy
● MEN2A (high risk): surgery in childhood
● Moderate risk mutations: individualized timing
Nerve & Parathyroid Preservation
Meticulous technique is essential.
Radioactive Iodine Therapy (RAI)
Not effective for MTC.
Salt-based therapies do not improve outcomes.
External Beam Radiation Therapy (EBRT)
Used selectively for:
● Unresectable tumors
● Positive margins
● Extensive nodal disease
● Local control after incomplete surgery
Delivered via IMRT.
Systemic Therapy for
Advanced/Metastatic MTC
1. Targeted Therapy (Highly Effective in RET-Mutated MTC)
A. RET-Specific Inhibitors (Preferred)
● Selpercatinib
● Pralsetinib
These drugs produce dramatic responses and are now first-line in metastatic disease.
B. Multi-Kinase Inhibitors (MKIs)
Used earlier but now second-line:
● Vandetanib
● Cabozantinib
Useful in RET-negative tumors as well.
2. Immunotherapy
● Pembrolizumab (selected cases with high PD-L1 or TMB)
3. Systemic Chemotherapy
Minimal role—reserved for rare refractory cases.
Follow-Up & Surveillance
Regular monitoring is critical.
Follow-Up Includes
● Serum calcitonin
● Serum CEA
● Neck ultrasound
● Cross-sectional imaging for rising markers
● Bone, liver, and lung imaging if metastatic risk is high
Doubling Time
Calcitonin and CEA doubling time predict prognosis more accurately than absolute levels.
Prognosis
Depends on:
● Stage at diagnosis
● Lymph node burden
● Distant metastasis
● RET mutation type
● Doubling time of calcitonin/CEA
10-year survival for localized MTC: 85–90 percent
Metastatic MTC has variable outcomes but improves significantly with RET inhibitors.
Special Considerations
1. Pheochromocytoma Screening
Must be done before thyroid surgery in hereditary cases to avoid hypertensive crisis
2. Children with RET Mutations
Preventive thyroidectomy may be recommended depending on risk
3. Aggressive Variants
MEN2B-associated MTC tends to present early and spread quickly.
Our Expertise at Coimbatore Cancer Clinic
● Expertise in thyroid and neck surgery for MTC
● Comprehensive MEN2 evaluation (adrenal, parathyroid assessment)
● RET mutation analysis and genetic counseling
● Precision neck dissection with nerve and parathyroid preservation
● Access to RET-targeted therapies (selpercatinib, pralsetinib)
● Long-term calcitonin/CEA–based surveillance
● Multidisciplinary supportive care for advanced disease
We offer complete, individualized care for every stage of MTC.
When to Consult
Seek evaluation if you have:
● Thyroid nodule with elevated calcitonin
● Family history of MTC or MEN2
● Unexplained diarrhea or flushing
● Neck swelling
● Hoarseness
● Enlarged neck nodes
Early diagnosis is essential for best outcomes.
Frequently Asked Questions
Disclaimer
This page provides general medical information for patient education. Individual treatment
decisions must be made in consultation with qualified surgical and medical oncologists.
Anaplastic Thyroid Carcinoma (ATC) –
Causes, Symptoms, Diagnosis, Treatment
& Latest Advances
Overview
Anaplastic Thyroid Carcinoma (ATC) is one of the most aggressive and lethal human
cancers, accounting for less than 2 percent of thyroid malignancies but responsible for a
disproportionate number of thyroid cancer deaths. ATC arises from undifferentiated
transformation of pre-existing differentiated thyroid cancer (PTC/FTC) in many cases.
ATC is characterized by:
● Rapid growth
● Early local invasion
● Early metastasis
● Life-threatening airway compromise
Because of its aggressiveness, management requires immediate, coordinated,
multidisciplinary care, including surgery, radiation, chemotherapy, targeted therapy, and
immunotherapy.
At Coimbatore Cancer Clinic, our surgical and medical oncologists provide rapid
evaluation, airway stabilization, surgically feasible interventions, and access to modern targeted
therapies (BRAF/MEK inhibitors, immunotherapy) based on NCCN 2025 guidelines.
Causes & Risk Factors
1. Pre-existing Thyroid Cancer
Often arises from longstanding differentiated thyroid cancer (PTC/FTC).
2. Age
Occurs mostly after age 60.
3. Gender
More common in women.
4. Radiation Exposure
History of neck radiation increases risk.
5. Genetic Mutations
Common mutations include
● BRAF V600E
● TP53
● TERT promoter mutations
● RAS mutations
Mutational profile strongly influences treatment options.
Symptoms & Warning Signs
ATC progresses rapidly—symptoms often worsen within weeks.
Local Symptoms
● Rapidly enlarging neck mass
● Severe neck pain
● Difficulty swallowing
● Hoarseness
● Stridor (noisy breathing)
● Visible neck swelling
Airway Compromise
A medical emergency:
● Shortness of breath
● Wheezing
● Cyanosis
Advanced Symptoms
● Cough
● Weight loss
● Bone pain
● Coughing blood
Any rapidly expanding thyroid mass must be evaluated urgently.
Diagnostic Evaluation
1. Clinical Examination
Focused on:
● Airway
● Vocal cord mobility
● Local invasion
2. Ultrasound
Initial assessment of thyroid and nodes.
3. FNAC or Core Biopsy
Confirms diagnosis—ATC typically shows undifferentiated cells.
4. Molecular Profiling (Strongly Recommended)
Identifies:
● Airway
● Vocal cord mobility
● Local invasion
Essential for targeted therapy selection.
5. Imaging
● CT neck and chest – evaluates tracheal invasion
● MRI – local extension
● PET-CT – staging and detection of metastasis
6. Airway Assessment
Many patients may require emergent airway support.
● IVA: Local disease
● IVB: Regional extension
● IVC: Distant metastasis
This reflects its uniformly aggressive nature.
Treatment – According to NCCN 2025
ATC requires immediate and aggressive multimodality therapy.
1. Airway Management (First Priority)
Airway obstruction is common.
Options
● Endotracheal intubation
● Tracheostomy (often necessary and life-saving)
● Avoid emergency tracheostomy if possible (bleeding risk)
Stabilizing the airway enables further treatment.
2. Surgery (If Tumor Is Resectable)
Goal: Complete gross tumor removal.
Possible surgeries:
● Total thyroidectomy
● En bloc resection of involved structures
● Neck dissection if nodes involved
Surgery is only performed if complete resection seems feasible.
If unresectable, surgery is avoided and systemic therapy begins immediately.
3. External Beam Radiation Therapy
(IMRT)
Used:
● After surgery (adjuvant)
● With chemotherapy
● Definitively when surgery is not possible
Benefits:
● Improves local control
● Prevents airway narrowing
Regimens: 60–66 Gy with concurrent systemic therapy.
4. Systemic Therapy – Cornerstone of
Modern ATC Treatment
A. Targeted Therapy (If Gene Mutations Present)
1. BRAF V600E Mutation Positive (40–60 percent)
Treatment of choice:
● Dabrafenib + Trametinib (BRAF + MEK inhibition)
This combination:
● Shrinks tumors rapidly
● Can convert unresectable to resectable disease
● Improves survival significantly
This is the most effective therapy for eligible patients.
2. RET Fusion Positive
● Selpercatinib
● Pralsetinib
3. NTRK Fusion Positive
● Larotrectinib
● Entrectinib
These can stabilize or shrink tumors dramatically.
B. Immunotherapy
Used in:
● High tumor mutational burden
● PD-L1 positive tumors
● MSI-high cancers
Agents:
● Pembrolizumab
● Nivolumab
Can be combined with targeted therapy in selected cases.
C. Cytotoxic Chemotherapy
Used when targeted options are unavailable:
● Paclitaxel
● Carboplatin
● Doxorubicin
● Combination regimens
Less effective but palliative.
Treatment Strategy Based on Resectability
1. Resectable ATC
● Rapid molecular profiling
● Surgery
● Adjuvant chemoradiation ± targeted therapy
2. Borderline Resectable ATC
● Start targeted therapy (BRAF/RET/NTRK inhibitor)
● Re-evaluate for surgery after tumor shrinkage
3. Unresectable ATC
● Targeted therapy immediately
● Chemoradiotherapy
● Immunotherapy for progression
Recurrent or Metastatic ATC
Management includes:
● Targeted therapy
● Immunotherapy
● Palliative radiation
● Airway or esophageal stenting
● Pain management
● Nutritional support
Median survival has improved significantly with targeted agents.
Supportive & Palliative Care
Essential components:
● Airway support
● Nutritional care (feeding tubes if required)
● Pain control
● Tracheostomy care training
● Psychosocial support
● Counseling for patient and family
Early palliative care improves quality of life
Prognosis
ATC has historically had a poor prognosis, but modern targeted therapies have improved
survival.
Factors influencing prognosis:
● Tumor resectability
● BRAF/RET/NTRK mutation status
● Distant metastasis
● Response to targeted therapy
● Age and comorbidities
With targeted therapies, some patients achieve meaningful long-term control.
Our Expertise at Coimbatore Cancer Clinic
● Rapid evaluation and airway management
● Expertise in high-risk thyroid and neck surgery
● Advanced IMRT coordination with expert radiation oncologists
● Access to BRAF-, RET-, and NTRK-targeted therapies
● Immunotherapy for advanced disease
● Palliative and supportive care services
● Continuous follow-up for disease response and complications
We offer urgent, aggressive, and personalized treatment for ATC to improve survival and
maintain quality of life.
When to Consult
Seek immediate evaluation if you have:
● Rapid neck swelling
● Breathing difficulty
● Sudden hoarseness
● Difficulty swallowing
● Painful, hard thyroid mass
● Enlarged neck nodes
ATC is a medical emergency—early treatment saves lives.
Frequently Asked Questions (FAQs)
Disclaimer
This page provides general medical information. Treatment must be individualized based on
consultation with qualified surgical and medical oncologists.
Parathyroid Tumors – Primary
Hyperparathyroidism, Parathyroid
Adenoma & Parathyroid Carcinoma
Overview
The parathyroid glands are four small endocrine glands located behind the thyroid. They
produce parathyroid hormone (PTH), which regulates calcium and bone metabolism.
Disorders of the parathyroid glands cause abnormal PTH production, leading to high calcium
levels (hypercalcemia) and affecting bones, kidneys, and digestion.
Most parathyroid tumors are benign adenomas, but a small percentage represent parathyroid
carcinoma, an aggressive cancer. Early diagnosis and surgical removal are key to preventing
long-term complications such as kidney stones, bone disease, and cardiovascular problems.
At Coimbatore Cancer Clinic, our surgical and medical oncologists provide advanced
evaluation, accurate localization, expert parathyroid surgery, minimally invasive techniques,
cancer management, and lifelong calcium/PTH monitoring based on NCCN and endocrine
surgery guidelines
Types of Parathyroid Disorders
1. Primary Hyperparathyroidism (PHPT)
Most common disorder. Caused by:
● Single parathyroid adenoma (80–85 percent)
● Multigland hyperplasia (10–15 percent)
● Parathyroid carcinoma (rare)
2. Parathyroid Adenoma
Benign tumor overproducing PTH.
3. Parathyroid Hyperplasia
All four glands enlarged.
4. Parathyroid Carcinoma
Rare but aggressive cancer causing severe hypercalcemia.
Causes & Risk Factors
1. Radiation Exposure
Childhood head/neck radiation increases risk.
2. Genetic Syndromes
● MEN1
● MEN2A
● Hyperparathyroidism-jaw tumor syndrome (HPT-JT)
● Familial isolated hyperparathyroidism
3. Kidney Disease
In secondary hyperparathyroidism.
4. Female Gender
More common in women.
5. Age
Increases with age; common after 50.
Symptoms & Warning Signs
Classic symptoms are remembered as “Bones, Stones, Groans & Psychic Moans.”
Bone Symptoms
● Bone pain
● Osteoporosis
● Fragility fractures
Kidney Symptoms
● Kidney stones
● Frequent urination
● Kidney dysfunction
Gastrointestinal Symptoms
● Nausea
● Constipation
● Abdominal pain
● Pancreatitis
Neuropsychiatric Symptoms
● Fatigue
● Depression
● Memory problems
● Irritability
Parathyroid Carcinoma Symptoms (Severe)
● Extremely high calcium levels
● Bone disease
● Palpable neck mass
● Recurrent laryngeal nerve palsy
Diagnostic Evaluation
1. Blood Tests
● Elevated total calcium
● Elevated or inappropriately normal PTH
● Low phosphorus
● Vitamin D level
● Kidney function tests
2. 24-hour Urine Calcium
Differentiates primary hyperparathyroidism from familial hypocalciuric hypercalcemia.
3. Imaging for Localization
Used after diagnosis to identify the gland for surgery:
● Ultrasound of neck
● Sestamibi parathyroid scan
● 4D-CT scan (high accuracy for ectopic glands)
● MRI in selected cases
4. Bone Density (DEXA scan)
Evaluates osteoporosis.
5. Imaging for Parathyroid Carcinoma
● CT/MRI
● PET-CT for metastasis
Staging of Parathyroid Carcinoma
There is no formal AJCC staging system.
Assessment is based on:
● Local invasion
● Lymph node spread
● Distant metastasis (lungs, bones, liver)
Treatment – According to Guidelines
Surgery is the only curative treatment for parathyroid tumors, including
primary hyperparathyroidism and parathyroid carcinoma.
1. Surgical Management
A. Minimally Invasive Parathyroidectomy (MIP)
Used when a single adenoma is localized.
Advantages:
● Small incision
● Short surgery time
● Quick recovery
B. Bilateral Neck Exploration
Done when:
● Localization scans are negative
● Multiple adenomas suspected
● Parathyroid hyperplasia present
C. Parathyroid Carcinoma Surgery
Requires:
● En bloc resection of tumor
● Removal of involved tissues
● Ipsilateral thyroid lobectomy
● Central neck dissection if nodes positive
Key principle: Avoid capsule rupture, as it increases recurrence.
Intraoperative PTH Monitoring
A >50 percent drop in PTH within 10 minutes confirms successful removal.
2. Non-Surgical Management
Used only when surgery is not possible.
For Primary Hyperparathyroidism
● Cinacalcet (calcimimetic)
● Bisphosphonates or denosumab for bone protection
For Parathyroid Carcinoma
Limited role for:
● Radiation (rare use)
● Chemotherapy (ineffective)
Targeted therapy and immunotherapy are investigational.
3. Management of Severe Hypercalcemia
Emergency Treatment
● IV fluids
● Calcitonin
● Bisphosphonates
● Dialysis in severe cases
● Cinacalcet
Common in parathyroid carcinoma.
Postoperative Care
1. Calcium & Vitamin D Supplementation
Because remaining glands may be suppressed.
2. Monitor for “Hungry Bone Syndrome”
Occurs especially in:
● Severe PHPT
● Long-standing disease
● Parathyroid carcinoma
Requires aggressive calcium replacement.
3. Voice Monitoring
To assess recurrent laryngeal nerve function.
Recurrent or Metastatic Parathyroid
Carcinoma
Treatment Options
● Re-operation (best option)
● Debulking surgery for symptom relief
● External beam radiation (limited)
● Targeted therapy (under research)
● Palliative care in advanced disease
High calcium levels require ongoing management
Long-Term Follow-Up & Surveillance
For Parathyroid Adenoma (Post-Surgery)
● Calcium & PTH at 6 weeks, 6 months, then annually
For Hyperplasia
Long-term monitoring for recurrence.
For Parathyroid Carcinoma
Lifelong follow-up with:
● Serum calcium
● PTH
● Imaging for recurrence
● Monitoring for hypercalcemia symptoms
Prognosis
Adenomas & Hyperplasia
Excellent prognosis after surgery.
Parathyroid Carcinoma
Depends on:
● Early diagnosis
● Complete en bloc removal
● Absence of metastasis
10-year survival varies widely but improves with complete surgery.
Special Considerations
MEN Syndromes
Patients require:
● Genetic testing
● Screening for associated tumors (thyroid, adrenal, pancreas)
Ectopic Parathyroid Glands
May occur in:
● Mediastinum
● Tracheoesophageal groove
● Carotid sheath
4D-CT and sestamibi help localize.
Our Expertise at Coimbatore Cancer Clinic
● Expertise in minimally invasive parathyroid surgery
● Skilled in complex parathyroid carcinoma resections
● Intraoperative PTH monitoring
● Precision localization using ultrasound, sestamibi, 4D-CT
● Multidisciplinary management of MEN syndromes
● Medical therapy for hypercalcemia
● Long-term calcium/PTH follow-up
We aim for complete cure with safe and effective surgical care.
When to Consult
Seek medical evaluation if you experience:
● Kidney stones
● Bone pain
● Excessive fatigue
● Depression
● Persistent high calcium
● Neck swelling
● Family history of parathyroid disease or MEN syndrome
Early treatment prevents lifelong complications.
Frequently Asked Questions (FAQs)
Disclaimer
This page provides general information for patient education. Individual treatment plans must be
made after consultation with qualified surgical and medical oncologists.
