Medullary thyroid cancer: management guidelines of the American Thyroid Association.
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.
Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, The Arthur G. James Cancer Hospital, Columbus, Ohio 43210, USA. richard.kloos@osumc.edu
Kloos
Richard T
RT
Eng
Charis
C
Evans
Douglas B
DB
Francis
Gary L
GL
Gagel
Robert F
RF
Gharib
Hossein
H
Moley
Jeffrey F
JF
Pacini
Furio
F
Ringel
Matthew D
MD
Schlumberger
Martin
M
Wells
Samuel A
SA
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018276:Carcinoma, Medullary / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009626:Terminology as Topic; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
D000970:Antineoplastic Agents