Current Guidelines for Management of Medullary Thyroid Carcinoma
Open accessAbstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from the parafollicular cells. The diagnostic and therapeutic strategies for the condition are different from those used for well-differentiated thyroid cancer. Since the 2015 American Thyroid Association guidelines for the diagnosis and treatment of MTC, the latest, including the National Comprehensive Cancer Network and European Association for Medical Oncology guidelines have been updated to reflect several recent advances in the management of MTC. Advances in molecular diagnosis and postoperative risk stratification systems have led to individualized treatment and follow-up strategies. Multi-kinase inhibitors, such as vandetanib and cabozantinib, can prolong disease progression-free survival with favorable adverse effects. In addition, potent selective rearranged during transfection (RET) inhibitors (selpercatinib and pralsetinib) have shown a promising efficacy in recent clinical trials. This review summarizes the management of MTC in recent guidelines focused on sporadic MTC.
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The most commonly used photosensitizers in PDT for thyroid cancers include hypericin, porphyrin, photophrin, radachlorin, and 5-aminolevulinic acid (ALA).
“The most commonly used PS in PDT for the treatment of thyroid cancers include hypericin, porphyrin, photophrin, radachlorin, and 5-aminolevulinic acid (ALA). [8-10,14,32]”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The 'Management in Persistent or Recurrent MTC' section discusses radionuclide therapy and other treatments, but does not address photodynamic therapy or photosensitizers. Searches for PDT, photosensitizers, and the named compounds found no passage supporting the claimed list or its frequency of use. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTreatment of the cell line with PDT using photophrin at 0.8 and 1.6 mg/ml reduced cell viability, to a greater extent at higher photophrin concentrations.
“Treatment of the cell line with PDT using photophrin at concentrations of 0.8 and 1.6 mg/ml reduced cell viability, to a greater extent at higher photophrin concentrations.”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The section on management of persistent or recurrent medullary thyroid carcinoma discusses drug therapy and radionuclide therapy, but not photodynamic therapy in a cell line. Searches for photophrin, the 0.8 and 1.6 mg/ml concentrations, and cell viability found no passage addressing the claimed result; page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe changes were particularly marked in higher concentrations of the photosensitizer or in combination with sulforaphene, carboplatin, or genistein.
“The changes were particularly marked in higher concentrations of the photosensitizer or in combination with sulforaphene, carboplatin, or genistein.”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The Management in Persistent or Recurrent MTC section discusses kinase inhibitors, chemotherapy, and radionuclide therapy, but not changes at higher photosensitizer concentrations or combinations with sulforaphene, carboplatin, or genistein. Searches for those substances and for photodynamic therapy found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn combined therapy compared to individual therapies, after 6 h, a greater number of apoptotic cells, covering almost all cells, was observed.
“a greater number of apoptotic cells, covering almost all cells”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The Management in Persistent or Recurrent MTC section discusses treatment regimens and clinical outcomes, but not apoptotic-cell counts after six hours. Searches for the quoted apoptotic-cell observation and for six-hour combination-therapy results found no passage addressing the claim in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredTreatment of cells with genistein alone, regardless of time interval (3, 6, 24 h) and concentration (25, 50, 100 mM), did not result in changes in cell viability.
“It was shown that treatment of cells with genistein, regardless of the time interval (3, 6 and 24 h) and concentration (25, 50, 100 mM) did not result in changes in cell viability.”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The cited paper’s ‘Management in Persistent or Recurrent MTC’ section discusses clinical treatments, including vandetanib and cabozantinib, rather than genistein-treated cells. Searches of our full-text copy for genistein, cell viability, and the stated treatment times and concentrations found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
In combined therapy after 6 h, increased expression of caspase 3, 8, 9, 12, PARP, CHOP, Bax, cytochrome c, and AIF was observed.
“increased expression of caspase 3, 8, 9, 12, PARP, CHOP, Bax, cytochrome c, AIF”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The Management in Persistent or Recurrent MTC section discusses treatment regimens and clinical outcomes, but not caspases or the other listed apoptosis markers. Searches for the marker list and for increased expression after six hours of combined therapy found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredCell viability was significantly inhibited in combination therapy.
“However, cell viability was significantly inhibited in the combination therapy.”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The Management in Persistent or Recurrent MTC section discusses combination chemotherapy as a treatment option and reports clinical outcomes for other therapies, but does not report cell-viability results for combination therapy. Searches for cell viability and combination-treatment inhibition found no passage addressing the claimed result; no page number was provided in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn combined therapy after 6 h, a higher level of ROS was observed.
“and a higher level of ROS”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The passages in “Management in Persistent or Recurrent MTC” discuss treatment outcomes, including calcitonin levels and survival, but do not address ROS measurements. Searches for combined therapy after six hours and for reactive oxygen species found no passage supporting the claimed higher ROS level. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThese changes were more pronounced when using higher concentrations of photophrin.
“and the above changes were more pronounced when using higher concentrations of photophrin.”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The supplied passages and searches for photophrin, Photofrin, and concentration-dependent effects found no discussion of photophrin or changes at higher concentrations. The paper’s Management in Persistent or Recurrent MTC section instead discusses treatments such as pralsetinib; that does not establish or contradict the claimed photophrin effect. (LLM, conf=0.77)
Experimental — accuracy not yet measuredIn combined therapy after 6 h, a greater degree of mitochondrial membrane depolarization was observed.
“a greater degree of mitochondrial membrane depolarization”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The paper’s ‘Management in Persistent or Recurrent MTC’ section discusses treatment guidelines and clinical outcomes, but does not address mitochondrial membrane depolarization after six hours of combined therapy. Searches for ‘mitochondrial membrane depolarization’ and ‘mitochondrial membrane potential’ with the six-hour condition found no supporting passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredIn combined therapy after 6 h, increased fluorescence intensity was observed.
“increased fluorescence intensity”
From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [32]
The section on management of persistent or recurrent medullary thyroid carcinoma discusses treatment outcomes, but not fluorescence intensity after six hours of combined therapy. Searches of our copy for the claimed fluorescence finding and its timing returned no relevant passage; page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Kim, M., & Kim, B. H.
- Affiliations
- Pusan National University Hospital (KR)
- Corresponding author
- Kim, Bo Hyun
- Venue
- Endocrinology and Metabolism
- Publisher
- Korean Endocrine Society
- Published
- 2021-06-30
- Volume
- 36
- Issue
- 3
- Pages
- 514-524
- ISSN
- 2093-596X (ISSN-L)
- 2093-5978
- PMC
- PMC8258323
- OpenAlex
- W3174879749
- Cited by
- 101
- References
- 46
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 29 · 2023: 18 · 2022: 9 · 2021: 3
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Endocrinology and Metabolism (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Pusan National University Hospital
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- medullary thyroid carcinoma, parafollicular cells, RET fusion, RET inhibitors, selpercatinib, pralsetinib, vandetanib, cabozantinib, multikinase inhibitor, postoperative risk stratification, molecular diagnosis, treatment guidelines, progression-free survival
- MeSH terms
- Humans, Thyroid Neoplasms, Carcinoma, Neuroendocrine, Protein Kinase Inhibitors
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