Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association, June 2009

The American Thyroid Association Guidelines Task Force*

Richard T. Kloos (Chair),1 Charis Eng,2 Douglas B. Evans,3 Gary L. Francis,4 Robert F. Gagel,5 Hossein Gharib,6 Jeffrey F. Moley,7 Furio Pacini,8 Matthew D. Ringel,9 Martin Schlumberger,10 and Samuel A. Wells Jr11

Background:  Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians.

Methods:  Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality.

Results:  Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research.

Conclusions:  One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.


  *Authorship listed in alphabetical order following the Task Force Chairperson.

1Departments of Internal Medicine and Radiology; Divisions of Endocrinology, Diabetes and Metabolism & Nuclear Medicine; The Ohio State University, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.

2Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, and Department of Genetics and CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

3Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

4Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia.

5Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.

6Mayo Clinic College of Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota.

7Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

8Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy.

9Department of Internal Medicine; Division of Endocrinology, Diabetes and Metabolism; The Ohio State University, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.

10Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris XI-Sud, Villejuif, France.

11Department of Surgery, Washington University Medical Center, St. Louis, Missouri.

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