To receive a maximum of 4.5 AMA PRA Category 1 Credits™, participants must complete the activity evaluation online at education.endocrine.org/ATA2015 by Saturday, April 4, 2015. Once completed, you will be able to print/save a CME certificate.

The American Thyroid Association (ATA) assembles groups of expert clinicians and scientists to evaluate published papers and recommend evidence-based guidelines for the diagnosis and management of thyroid cancer. Medullary thyroid carcinoma (MTC) accounts for 1-2% of thyroid cancers in the United States. The 2015 ATA MTC guidelines have been developed to assist clinicians of all specialties in the management of patients with MTC. Importantly, guidelines focused on children and the management of thyroid nodules and cancers have not been previously addressed. Therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from over-aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors were needed.

Authors from the international community of thyroid specialists in endocrinology, thyroid cancer, pediatric endocrinology and thyroid surgery discussed two sets of newly published ATA guidelines with special focus on the:

• ATA Medullary Thyroid Cancer Guidelines revised
• ATA Clinical Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer
• Case based applications of both sets of guidelines

Part I. ATA Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Background
Andrew J. Bauer, MD, Children’s Hospital of Philadelphia

Pediatric Task Force Composition and Guidelines Process

Pediatric Thyroid Nodules and Cancer—Why are Separate Guidelines Needed?

Pediatric Thyroid Nodules
Salvatore Benvenga, MD, Policlinico Universitario di Messina, Italy

Incidence and Risk of Cancer

Evaluation/Treatment of Pediatric Thyroid Nodules

Pre-operative Staging and Surgery
Geoffrey B. Thompson, M.D., Mayo Clinic

Pre-Operative Staging

Optimal Surgical Approach—Which Surgeon and What Procedure?

Risk Stratification and Post-operative Staging
Andrew J. Bauer, MD, Children’s Hospital of Philadelphia

ATA Pediatric Thyroid Cancer Risk Stratification

Post-Operative Staging Based upon Risk Stratification

The Role of RAI in Pediatric Thyroid Cancer
Markus Luster, MD, University of Marburg and University Hospital, Germany

Indications for RAI in Pediatric Thyroid Cancer

RAI Dose Selection

TSH Suppression and Surveillance
Catherine A. Dinauer, MD, Yale University School of Medicine

Role of TSH Suppression and TSH Goals

Use of US, RAI Scans, and Thyroglobulin Levels in the Long-Term Follow Up of Pediatric Thyroid Cancer

Appropriate Evaluation of the Patient with Known or Suspected Residual Disease

Management of Children with Distant Metastases
Steven G. Waguespack, MD, University of Texas M.D. Anderson Cancer Center

Role of RAI and Other Systemic Therapies in the Management of Pulmonary Metastasis

Panel Discussion with Questions from the Audience (all speakers)

Part II. ATA Management Guidelines for Medullary Thyroid Carcinoma

Background
Samuel A. Wells, Jr., MD, National Cancer Institute, National Institutes of Health

Etiology of Sporadic and Hereditary MTC

Clinical Characteristics and Relationship between Genotype and Phenotype of Sporadic and Hereditary MTC

Initial Evaluation of Patients with a Thyroid Nodule and Suspected MTC
Robert F. Gagel, MD, University of Texas M. D. Anderson Cancer Center

Direct DNA Analysis to Detect RET Germline Mutations in Patients with Apparent Sporadic MTC

Secretory Products of MTC

Ethical Considerations for Genetic Screening
M. Sara Rosenthal, PhD, University of Kentucky

Management of Patients with Clinically Evident MTC
Douglas B. Evans, MD, Medical College of Wisconsin

Management of Patients with MTC confined to the Thyroid Gland

Management of Patients with Advanced Local Disease

Management of Patients Who Have Had an Inadequate Initial Operation

Management of Children with Hereditary MTC
Steven G. Waguespack, MD, University of Texas M.D. Anderson Cancer Center

Prophylactic Thyroidectomy in Children with MEN2A or MEN2B

Management of Pheochromocyomas and Parathyroid Tumors in Patients with Hereditary MTC
Douglas B. Evans, MD, Medical College of Wisconsin

Treatment of Patients with Metastatic MTC
Bruce G. Robinson, MD, The University of Sydney

Management of patients with distant metastases

Management of patients with hormonally active metastases

Panel Discussion with Questions and Answers from the Audience (all speakers)

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer Faculty

Andrew J. Bauer, MD, Co-Chair
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Steven G. Waguespack, MD, Co-Chair
University of Texas M.D. Anderson Cancer Center, Houston, Texas

Salvatore Benvenga, MD
Policlinico Universitario di Messina, Italy

Catherine A. Dinauer, MD
Yale University School of Medicine, New Haven, Connecticut

Markus Luster, MD
University of Marburg and University Hospital, Marburg, Germany

Geoffrey B. Thompson, MD
Mayo Clinic, Rochester, Minnesota

Guidelines for the Management of Medullary Thyroid Carcinoma Faculty

Samuel A. Wells, Jr., MD, Chair
National Cancer Institute, National Institutes of Health, Bethesda, Maryland

Douglas B. Evans, MD
Medical College of Wisconsin, Milwaukee, Wisconsin

Robert F. Gagel, MD
University of Texas M. D. Anderson Cancer Center, Houston, Texas

Bruce G. Robinson, MD
University of Sydney, Sydney, Australia

M. Sara Rosenthal, PhD
University of Kentucky, Lexington, Kentucky

Steven G. Waguespack, MD
University of Texas M.D. Anderson Cancer Center, Houston, Texas

Upon completion of this educational activity, learners will be able to:

• Describe major changes in the 2015 ATA Guidelines on Medullary Thyroid Cancer (MTC) and how these should be applied in clinical practice
• Understand the inaugural ATA Guidelines on Pediatric Thyroid Nodules and Differentiated Thyroid Cancer (DTC) and how these guidelines differ from adult recommendations
• Describe the risk of malignancy and the appropriate evaluation and treatment in children with thyroid nodules
• Identify appropriate surgical approaches that reduce long-term recurrence while minimizing harm to the voice and parathyroid function in both MTC and pediatric DTC
• Apply risk stratification to post-operative staging to tailor radioactive (RAI) therapy, initial TSH goals, and monitoring in children with DTC
• Identify children who will and who may not benefit from RAI treatment and discuss approaches to the use of RAI to treat pulmonary metastases
• Apply appropriate monitoring techniques to patients with MTC who have persistently detectable calcitonin levels
• Identify patients with advanced and metastatic MTC who are appropriate candidates for monitoring, directed therapies, and systemic therapies
• Review the management of patients with multiple endocrine neoplasia type 2 (MEN2), including the timing of prophylactic thyroidectomy and management of pheochromocytoma and hyperparathyroidism in this population
• Describe the ethical considerations surrounding genetic testing in MTC and MEN2

This continuing medical education activity should be of substantial interest to the community of endocrinologists, internists, surgeons, basic scientists, nuclear medicine scientists, pathologists, trainees, nurses, physician assistants and other health care professionals who wish to broaden and update their knowledge on thyroid nodules, differentiated thyroid cancer and the current ATA guidelines surrounding these topics.