Medical Oncologist
CION Cancer Clinics
RET carrier surveillance: which checks, and when | CION Cancer Clinics
RET surveillance is a set of blood tests, and sometimes scans, that watch three glands: the thyroid, the adrenals and the parathyroids. When it starts depends on your exact RET variant, and it continues for life, even after the thyroid is removed. This page explains what each test looks for, how the schedule usually unfolds, and the warning signs that should not wait for your next appointment. At CION Cancer Clinics, our oncologists explain what a gene result means for you and your family, and plan the checks that follow.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What checks does a RET carrier need, and how often?
- What is each check actually looking for?
- How does the schedule usually unfold?
- The words on a surveillance report, in plain language
- What this page cannot tell you
- Four things carriers tell us, and what is actually true
- Common questions about RET surveillance
The short answer
What checks does a RET carrier need, and how often?
A RET carrier needs regular blood tests, and sometimes scans, that watch three glands: the thyroid, the two adrenal glands and the parathyroid glands in the neck. Most checks happen once a year. When they start depends on your exact RET variant, and they continue for life.
Why the thyroid comes first
Almost every RET carrier is at very high risk of medullary thyroid cancer. That is why most carriers have the thyroid removed early, before a cancer can form or spread. The surveillance after that is about checking the surgery did its job, and watching the other two glands.
Why checks continue after surgery
Removing the thyroid does not remove the RET fault. The adrenal glands can still grow a tumour called a phaeochromocytoma, and some variants raise the chance of an overactive parathyroid gland. Neither can be prevented by thyroid surgery. Both are found early by simple blood tests.
Why two carriers can have different schedules
RET faults are grouped by risk level, based on the exact spot in the gene that is changed. A higher-risk variant means earlier thyroid surgery and earlier adrenal checks. A moderate-risk variant means checks start later and surgery is timed by blood results.
Your schedule is set by your variant, not by your age alone. Ask your team which risk level your report falls into.Three glands, three tests
What is each check actually looking for?
Each test answers one question about one gland. None of them is painful, and most are a single blood sample.
The thyroid
A blood test for calcitonin, a hormone made by the cells where medullary thyroid cancer starts. A rising level is the earliest sign. CEA, a second blood marker, and a neck ultrasound are often added.
Used to
- Time thyroid surgery on moderate-risk variants
- Confirm surgery removed every cell
- Spot a return early
The adrenal glands
A blood or urine test for metanephrines, the breakdown products of adrenaline. High levels suggest a phaeochromocytoma, which can cause dangerous spikes in blood pressure. A scan follows only if the test is raised.
The parathyroid glands
A blood calcium level, with parathyroid hormone if calcium is high. An overactive gland can cause kidney stones, thinning bones and tiredness. This check matters for some variants and not others.
You, in person
A yearly visit to go over the results, check your blood pressure and ask about symptoms. It is also the time to update the family tree and ask whether any relative still needs testing.
Not sure whether this applies to you?
Ask an oncologist
!
One thing that cannot wait
Sudden attacks of a pounding headache, a racing heart and heavy sweating, especially with a very high blood pressure reading, can mean an adrenal tumour is releasing adrenaline. If an attack is severe, go to the nearest emergency department the same day and say you carry a RET fault. Do not agree to any operation, dental sedation or labour induction until the team knows about the RET fault and has checked your adrenal glands.
Across a lifetime
How does the schedule usually unfold?
-
A test for the family variant, early in life
Children of a carrier are tested for the known family fault, often in infancy for the highest-risk variant. A child who tests negative needs no RET checks at all.
-
A plan for the thyroid
For the highest-risk variant, surgery is advised within the first year of life. For high-risk variants it is planned in early childhood. For moderate-risk variants, calcitonin and neck scans start in early childhood and surgery is timed by the results.
-
Checks after surgery
Calcitonin and CEA are measured a few months after the operation. If they cannot be detected, the checks spread out to about once a year.
-
Adrenal and calcium tests begin
For higher-risk variants, these usually start around the age of eleven. For moderate-risk variants, around sixteen. After that, they repeat once a year.
-
Extra checks at key moments
Before any planned surgery and before or early in pregnancy, the adrenal test is repeated, even if the last one was recent.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
On your reports
The words on a surveillance report, in plain language
- Calcitonin
- A hormone made by the C cells of the thyroid. A rising level is the earliest sign of medullary thyroid cancer.
- CEA
- A second blood marker, used alongside calcitonin to follow medullary thyroid cancer after surgery.
- Metanephrines
- Breakdown products of adrenaline, measured in blood or urine to look for an adrenal tumour.
- Phaeochromocytoma
- A usually non-cancerous tumour of the adrenal gland that releases adrenaline and can raise blood pressure sharply.
- Primary hyperparathyroidism
- One or more parathyroid glands making too much hormone, which pushes blood calcium up.
- Risk level
- The group your exact RET variant falls into, usually called highest, high or moderate. It sets the timing of every check.
Being straight with you
What this page cannot tell you
It cannot give you your own schedule. The timings above are the usual pattern from international guidance. Your team may start earlier or check more often, depending on your variant, your blood results and what has happened to relatives.
It cannot read your report
What your specific variant means is a question for the counsellor who ordered the test. The same gene name covers variants with very different timings, so a relative's schedule is not a safe guide to yours.
Who this does not apply to
Relatives who test negative for the family variant need none of these checks. They carry the same risk as anyone else. If RET was found only in a tumour sample, it was not inherited, and the question is treatment rather than surveillance. That is covered under targeted therapy.
Keep every calcitonin, CEA and metanephrine report in one folder. The trend matters more than any single number.Commonly believed
Four things carriers tell us, and what is actually true
"My thyroid is out, so I am finished with checks."
The thyroid was only one of three glands at risk. The adrenal and parathyroid checks continue for life, and calcitonin is still watched to confirm no thyroid cells were left behind.
"I feel well, so I can skip this year."
An adrenal tumour or an overactive parathyroid gland is often silent for years. The blood test finds it before symptoms do, which is the whole point of checking.
"A normal calcitonin means my child can skip surgery."
For moderate-risk variants, calcitonin does help time surgery. For higher-risk variants, surgery is planned by age, because cancer can form before the blood test changes.
"High blood pressure at my age is just normal."
In a RET carrier, new or hard-to-control high blood pressure is a reason to repeat the adrenal test. Mention it at your next visit rather than treating it as ordinary.
Questions we are asked
Common questions about RET surveillance
How often will I need blood tests?
For most adult carriers, once a year. That visit usually covers calcitonin, CEA, metanephrines and calcium together. The first year after thyroid surgery has more frequent checks. Your team will shorten the gap if any result starts to rise.
Do I need to fast or stop medicines before the adrenal test?
Some laboratories ask you to rest lying down before the blood sample, and some medicines can affect the result. Ask the lab for its instructions a few days ahead. Never stop a prescribed medicine without asking the doctor who prescribed it.
What happens if my calcitonin goes up?
One raised result is usually repeated first. If the rise is confirmed, a neck ultrasound and sometimes other scans look for where the cells are. What happens next depends on those results and is planned by the thyroid surgeon and oncologist together.
Does my child need the same tests as me?
Only if the child carries the same variant. Children are tested for the family fault first. A carrier child follows a schedule set by the variant, which may mean thyroid surgery before any adrenal tests begin. A child who tests negative needs nothing more.
I am planning a pregnancy. What extra checks do I need?
A woman who carries RET should have the adrenal test before trying to conceive, or as early as possible in pregnancy. An undiscovered adrenal tumour is dangerous at delivery. If your thyroid has been removed, your tablet dose also needs checking early.
Are scans needed every year too?
Usually not. Blood tests do most of the work. A neck ultrasound is used around the time of thyroid surgery and whenever calcitonin rises. Adrenal scans are done when the metanephrine test is raised, not as a routine yearly step.
Can I have the tests done nearer home?
Calcium can be tested almost anywhere. Calcitonin and metanephrines need a reliable laboratory, and results compare best when the same lab is used each time. Ask the helpline how to combine the yearly tests and review into one visit to the city.
Will Aarogyasri or insurance pay for yearly checks?
Cover for routine surveillance in a well carrier varies. Thyroid surgery and cancer treatment are more often covered than yearly blood tests. Ask your insurer or the scheme desk in writing, and keep copies of the genetic report to support any claim.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Patient stories
Hear it from people we have treated
Every story is a video, in the patient's own words. Nothing here is a written testimonial.
Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. One helpline books a consultation at any of these centres, and your team will tell you where counselling and testing take place.
Warangal
Vizag
Sources
- American Thyroid Association (Thyroid journal) — Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma
- GeneReviews (NCBI) — Multiple Endocrine Neoplasia Type 2
- National Cancer Institute — Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ)
- MedlinePlus Genetics — Multiple endocrine neoplasia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Talk to us
Not sure which checks are due for you or your child?
Share the RET report and your last results. We will help set up a yearly schedule matched to your variant, with tests and review in one visit. One helpline serves every CION centre.