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In our series the prognosis of medullary carcinoma of thyroid (MCT) has improved during recent years due to earlier diagnosis and more systematic treatment. MCT remains confined to the neck for long periods of time. The surgical strategy should be based on this fact and on the occurrence and distribution of lymph node metastases. Lymph node metastases occurred in 90% of patients with palpable tumors. In those patients with hereditary MCT who had palpable tumors the lymph node metastases were distributed bilaterally in 88%. Hereditary cases with non-palpable thyroid tumors had lymph node metastases in 27%. During the last 15 years none of the patients with hereditary but 15% of those with sporadic disease died from MCT. During the same period 12 of 22 patients with lymph node metastases had their provoked calcitonin levels normalized by surgery.
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