Older males may have more aggressive disease, therefore should require at least total thyroidectomy. MEN I syndrome involves patients with a combination of findings including a pituitary mass, hyperparathyroidism and a pancreatic mass. A patient who has a preoperative diagnosis or suggestion of medullary carcinoma of the thyroid may require additional preoperative evaluation for any of the familial disorders. Specifically, a workup for pheochromocytoma should be included. An undiagnosed pheochromocytoma can result in serious anesthetic complications if not evaluated and treated preoperatively.
Medullary carcinoma carries a poorer prognosis than the well-differentiated carcinomas.
This incorporates removing all lymph nodes in the anterior part of the neck to evaluate possible metastatic spread. Anaplastic carcinoma of the thyroid is an extremely serious and aggressive thyroid cancer which often results in the death of the patient by local recurrence and metastatic spread within several months of diagnosis. This is usually seen in older patients who have the rapid onset of a thyroid mass, pain and hoarseness. Thyroidectomy is not often helpful in stopping the rapid progression of such thyroid cancer and a tracheostomy may be in order to aid breathing.