BACKGROUND
Medullary thyroid cancer is a relatively uncommon but important form of thyroid cancer. As is the case for all cancers, medullary thyroid cancer can grow over time and may eventually spread out of the thyroid to other parts of the body (a process called metastasis). Metastasis causes significant illness, or even death, and thus treating people diagnosed with medullary thyroid cancer to prevent, or at least control, its growth and spread is very important.

The most critical treatment for medullary thyroid cancer is surgery to remove the whole thyroid gland (called a total thyroidectomy). Because medullary cancer often has spread out of the thyroid to the neighboring neck lymph nodes by the time it is discovered, most experts now recommend surgical removal of these lymph nodes (called a central neck dissection) with the thyroid gland. It also appears increasingly clear that people diagnosed with medullary thyroid cancer who undergo thyroid and central neck dissection surgery under the care of a surgeon who specializes in thyroid surgery (called an endocrine surgeon) have lower risks of surgical complications, lower risk that thyroid cancer will come back after surgery (called recurrence) and better survival.

The authors of this study used large European patient databases to evaluate changes in the incidence of medullary thyroid cancer over the last 30 years, as well as to study how surgical treatment for this cancer has changed during this time frame. In particular, these researchers focused on studying the impact changes in surgical treatment have had on the recurrence risk and survival for people diagnosed with medullary thyroid cancer.

THE FULL ARTICLE TITLE
Jager EC et al. Trends in the incidence, organization of care, and surgical treatment of medullary thyroid cancer: a population-based study. Thyroid 2025;35(1):87-96; doi: 10.1089/thy.2024.0433. PMID: 39705074.

SUMMARY OF THE STUDY
The authors of this research studied two large databases that include the healthcare records for the population of the European country the Netherlands. They specifically reviewed 30 years of patient healthcare information (1989 to 2018) to determine if the rate of medullary thyroid cancer diagnosis changed during this time frame, as well as to see how surgical treatment might have changed and how these changes may have impacted the recurrence rate and survival for people diagnosed with this cancer.

A total of 818 cases of medullary thyroid cancer were identified by the study authors. Review of the associated health care records showed that the incidence of medullary thyroid cancer did not change during the 30-year time course assessed (the risk of developing medullary thyroid cancer stayed between 0.15 and 0.18 per 100,000 people). The probability of thyroid surgery being performed by an experienced surgeon increased from 41% to 86% over the study time course, however, as did the proportion of patients undergoing central neck dissection, rising from 77% to 93%. Although the risk of medullary thyroid cancer recurrence did not change during the study time frame, survival did, improving significantly from 55% to 88%.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This work shows that, for the large European population evaluated, the risk of developing medullary thyroid cancer has stayed the same over time. Thus, the factors that might increase a person’s chances of developing this cancer (which are largely unknown) have not expanded, at least not in the Netherlands. Importantly, the authors also found that the increased probability of treatment by an expert surgeon seen over the study time course, with more people undergoing central neck dissection in addition to total thyroidectomy. While this did not decrease the chances of this cancer coming back, the chances of surviving this cancer improved significantly. These findings show that people whose surgery is performed by an expert surgeon, with a central neck dissection, are more likely to survive in general and that when medullary thyroid cancer does recur after such surgery, this is less likely to cause death. For these reasons, people diagnosed with medullary thyroid cancer should be referred to an endocrine surgeon for their care and surgery should include both total thyroidectomy and central neck dissection.

— Jason D. Prescott, MD PhD

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