A patient presented with neck swelling. Cytology showed showed parafollicular cells along with clusters of plasmacytoid and few spindle shaped cells. What investigation should be done to follow up the patient?
**Core Concept**
The patient's presentation with neck swelling and cytology findings of parafollicular cells, plasmacytoid cells, and spindle-shaped cells suggests a diagnosis of medullary thyroid carcinoma (MTC). MTC is a type of thyroid cancer that arises from the parafollicular cells, also known as C cells, which produce calcitonin.
**Why the Correct Answer is Right**
Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland. In the context of MTC, calcitonin levels are often elevated, and its measurement serves as a tumor marker for this disease. A significant increase in calcitonin levels can indicate the presence of MTC, allowing for further diagnostic evaluation and treatment planning. The measurement of calcitonin has become a crucial tool in the diagnosis and management of MTC.
**Why Each Wrong Option is Incorrect**
**Option B:** TSH (Thyroid-Stimulating Hormone) level is a useful investigation for evaluating thyroid function and can help diagnose thyroid disorders such as hypothyroidism or hyperthyroidism. However, it is not directly related to the diagnosis of MTC.
**Option C:** Anti-TPO (Thyroid Peroxidase) antibody is a marker for autoimmune thyroiditis, such as Hashimoto's thyroiditis or Graves' disease. While thyroiditis can cause neck swelling, the cytology findings in this case are more suggestive of a malignant process.
**Option D:** TRH (Thyrotropin-Releasing Hormone) is a hormone involved in the regulation of thyroid function, but its measurement is not directly relevant to the diagnosis of MTC.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that medullary thyroid carcinoma can occur in the absence of familial syndromes, such as MEN 2A or MEN 2B. A high level of clinical suspicion and appropriate diagnostic evaluation, including calcitonin measurement, are crucial for early detection and treatment of MTC.
**✓ Correct Answer: A. Calcitonin**