After surgery, he had complete resolution of his symptoms of flushing and the rash. He also had an incidental 0.7-cm papillary thyroid carcinoma in the midportion of the right lobe of the thyroid.
He underwent a near-total thyroidectomy, and pathology showed that the MTC formed a 1.8-by-1.4-by-1.1-cm mass. Bidirectional sequence analysis was performed to test for the presence of a mutation in exons 10, 11, 13, 14, 15 and 16 of the RET proto-oncogene and was negative. Fine-needle aspiration biopsy findings were consistent with medullary thyroid carcinoma (MTC). Ultrasound of the thyroid showed a 1.8-cm suspicious nodule in the midright thyroid lobe. Based on this information, thyroid ultrasound was obtained. Tests for other potential causes of flushing disorder were obtained, which were remarkable for a serum calcitonin concentration markedly elevated at 552 pg/mL (normal < 16 pg/mL).
#CAUSE OF FLUSHING SKIN#
Skin biopsies showed multiple telangiectasias and no sign of mast cell abnormalities.
The 24-hour urine for 2,3-dinor-11beta-prostaglandin F2-alpha was mildly increased at 1,363 ng (normal, < 1,000 ng).
The thyroid appeared normal on examination, without any nodules appreciated on palpation. With his arms raised his facial flush did not change. On physical examination, he had a moderately flushed face and a diffuse red rash over his back. Photographs taken before (A) and three months after (B) surgery to resect medullary thyroid cancer.
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