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Ana Herrero Ruiz
Complejo Asistencial Universitario de Salamanca
España
https://orcid.org/0000-0002-5478-2701
Ana Isabel Sánchez Marcos
Complejo Asistencial Universitario de Salamanca
España
https://orcid.org/0000-0001-5744-1630
María Angeles Martín Almendra
Complejo Asistencial Universitario de Salamanca
España
María García Duque
Complejo Asistencial Universitario de Salamanca
España
https://orcid.org/0000-0001-6823-2519
Louisa Myriam Beaulieu Oriol
Complejo Asistencial Universitario de Salamanca
España
María Teresa Mories Álvarez
Complejo Asistencial Universitario de Salamanca
España
https://orcid.org/0000-0001-9789-0019
Vol. 13 Núm. 2 (2022), Artículo de revisión, Páginas e27141
DOI: https://doi.org/10.14201/orl.27141
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Resumen

Introducción: El carcinoma medular de tiroides (CMT) es un tumor maligno neuroendocrino poco frecuente derivado de las células parafoliculares o células C del tiroides. En el momento del diagnóstico presentan metástasis ganglionares más del 50% y a distancia el 10%.  Su pronóstico depende en gran parte del estadio del tumor, por lo que su diagnóstico temprano es fundamental.
Objetivo: El objetivo de este trabajo es realizar una revisión actualizada sobre el abordaje diagnóstico del CMT.
Síntesis: La ecografía es la principal herramienta en la estratificación del nódulo tiroideo, pero la mayor parte de los estudios se han centrado en el carcinoma papilar de tiroides. En el caso del CMT las características ecográficas sospechosas de malignidad suelen ser menos frecuentes y esto podría conducir a un retraso diagnóstico y terapéutico, por lo que se debe combinar con técnicas diagnósticas adicionales. En estos tumores la sensibilidad del estudio citológico del nódulo mediante punción aspiración con aguja fina generalmente es baja, y en aquellos casos de sospecha de CMT se recomienda realizar inmunohistoquímica para calcitonina y determinar la calcitonina en el aspirado de la punción. La calcitonina plasmática es el marcador más sensible para el diagnóstico de estos pacientes, pero su determinación rutinaria en el estudio del nódulo tiroideo es controvertida. Sus niveles se relacionan con la masa de células C y la presencia de metástasis ganglionares. Si son superiores a 500 pg/ml se recomienda realizar estudio de extensión con pruebas de imagen complementarias por sospecha de enfermedad metastásica. Es importante solicitar estudio genético a todos los pacientes, ya que el 25% son hereditarios formando parte de la neoplasia endocrina múltiple tipo 2 asociada a mutación en el gen RET.

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