PMC6925804_01
Calcitonin levels while on Vandetanib therapy. The graph depicts levels at baseline before the treatment was started, followed by initiation of Vandetanib, and subsequent rise in calcitonin levels after the therapy was stopped.
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Laboratory tests revealed elevated calcitonin level, 11,290 pg/mL (ref. value <7.6 pg/mL) (Figure 1). Her calcitonin level increased to 20,503 pg/mL (Figure 1).
(a) Thyroid ultrasound demonstrating hypoechoic lesion. (b) Preoperative CT of the neck (left) and the abdomen (right) revealing cervical lymphadenopathy and liver metastasis.
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Ultrasound of the neck identified a highly suspicious thyroid mass (Figure 2(a)), and a CT scan showed a heterogeneous thyroid nodule, and several enhanced lesions in the liver (Figure 2(b)).
Liver biopsy showing metastatic medullary thyroid carcinoma cells (x10) (a) H&E stain. (b) Calcitonin stain.
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A liver biopsy revealed that tumor was of neuroendocrine origin consistent with the medullary carcinoma of the thyroid (Figure 3).