A 49-year-old male patient with a history of common variable hypogamma globulinemia, chronic nodular lymphoid arthritis due to tachyardia and total gastrectomy due to gastric cancer in 2002.
In 2006, a thyroid nodule was discovered with FNA suggestive of malignancy. A total thyroidectomy was performed. The pathological anatomy confirmed the presence of a localized thyroid medullary carcinoma of 1.8 x 1.5 cm well-defined lymph node metastasis stage I.
The patient was referred to endocrinology for post-surgical follow-up of medullary carcinoma.
Upon arrival to the clinic nutritional assessment is performed. The patient has chronic diarrhea (with repeated periods of worsening) and his weight is 55 kg presenting a BMI of 19 kg/m2.
The laboratory tests showed hypocalcemia, iron deficiency anemia and altered liver profile.
Calcitonin and CEA levels are normal.
The patient was being treated with calcium and vitamin D supplements and levothyroxine.
Since it had not been performed before surgery, calcium, phosphorus, PTH and Metanephrine levels were determined in 24-hour urine that ruled out PEM.
A genetic study was also performed, which was negative.
During follow-up, the patient maintains calcium levels between 7.2 and 8.7 mg/dl with a progressive increase in intact PTH, indicating the development of secondary hyperparathyroidism.
Chronic diarrhea makes it difficult for patients to achieve compliance with treatment, reducing several times the patient himself the recommended doses in consultation of calcium, vitamin D and levothyroxine, whose consistency is associated with a decrease in the
The weight is maintained throughout the follow-up between 52 and 56.5 kg, being 56.2 kg in the last clinical review (BMI: 19.4 kg/m2).
The patient also remains in digestive periodic reviews, requiring admission in September 2008 for worsening of abdominal symptoms (diarrhoea) and for the study of hypertransaminasemia, performing during the admission study that was negative (AUC).
Treatment with monthly vitamin B12, folic acid multivitamin complexes and pancreatic enzymes was initiated during follow-up in order to improve their nutritional parameters.
Calcitonin levels remain undetectable in clinical studies.
