National Trends in the Surgical Treatment of Non-advanced Medullary Thyroid Cancer (MTC): An Evaluation of Adherence with the 2009 American Thyroid Association Guidelines

2016 ◽  
Vol 40 (12) ◽  
pp. 2930-2940 ◽  
Author(s):  
Eun Hae Estelle Chang ◽  
Waseem Lutfi ◽  
Joseph Feinglass ◽  
Alexandra Eudokia Reiher ◽  
Tricia Moo-Young ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Surgical Treatment ◽  
Medullary Thyroid Cancer ◽  
American Thyroid Association ◽  
Medullary Thyroid ◽  
National Trends

Surgical management of medullary thyroid cancer: which guidelines should we follow?

2015 ◽  
Vol 129 (5) ◽  
pp. 478-483 ◽  
Author(s):  
A Bowen ◽  
N Mani ◽  
S Penney ◽  
S Loughran ◽  
B Yap
Keyword(s):  
Thyroid Cancer ◽  
Surgical Management ◽  
Medullary Thyroid Cancer ◽  
Stage I ◽  
Disease Stage ◽  
American Thyroid Association ◽  
Cure Rate ◽  
Aggressive Approach ◽  
Medullary Thyroid ◽  
Biochemical Cure

AbstractBackground:Surgery is currently the only curative treatment for medullary thyroid cancer. Unfortunately, the surgical strategy that will offer patients at each disease stage the best chance of a biochemical cure remains unclear. The American Thyroid Association and British Thyroid Association guidelines offer different strategies.Methods:A retrospective analysis of the surgical management of 47 patients with medullary thyroid cancer diagnosed between 1994 and 2013 was performed. Surgical management was compared with current American Thyroid Association and British Thyroid Association guidelines. Outcome was defined as the first post-operative calcitonin measurement.Results:All patients with stage I–III disease achieved a post-operative biochemical cure regardless of the guidelines followed. The overall biochemical cure rate for patients with stage IVa disease was significantly reduced to 10 per cent (p < 0.01), but the biochemical cure rate for stage IVa disease patients who underwent bilateral lateral lymph node dissection was 33.3 per cent.Conclusion:The conservative, surveillance-driven approach recommended by the American Thyroid Association is appropriate for stage I–III disease. However, the more aggressive approach advocated by the British Thyroid Association might provide stage IVa disease patients a greater chance of achieving a biochemical cure.

scholarly journals Medullary Thyroid Cancer

1997 ◽  
Vol 4 (1) ◽  
pp. 25-29
Author(s):  
Michael G. Franz
Keyword(s):  
Thyroid Cancer ◽  
Surgical Treatment ◽  
Medullary Thyroid Cancer ◽  
Early Stage ◽  
Medullary Carcinoma ◽  
Early Stage Disease ◽  
Medullary Thyroid ◽  
Central Lymph Node Dissection ◽  
Familial Tumors ◽  
Thyroid Malignancies

Background Medullary thyroid cancer, a tumor of the parafollicular C cells, accounts for approximately 10% of all thyroid malignancies. An estimated 75% of cases are sporadic, and the remaining 25% are familial. Methods The author reviews the clinical features and diagnostic tests for this entity, as well as the surgical treatment of recurrent or persistent medullary carcinoma. Results Sporadic medullary thyroid cancer typically presents as an isolated unilateral mass. Familial tumors tend to be multifocal and bilateral. In patients with multiple endocrine neoplasia type 2A, pheochromocytomas and parathyroid hyperplasia also may develop. Care is taken to avoid operating on a patient with occult pheochromocytoma. Total thyroidectomy and central lymph node dissection are the keys for successful surgical treatment. Conclusions Surgery is the cornerstone of treatment for medullary carcinoma of the thyroid. Genetic testing using the ret oncogene allows identification of individuals who are at risk for the disease or those with early-stage disease.

scholarly journals Late-Onset Medullary Thyroid Cancer in a Patient with a Germline RET Codon C634R Mutation

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1448
Author(s):  
Agnieszka Walczyk ◽  
Kajetan Zgubieński ◽  
Grzegorz Chmielewski ◽  
Kinga Hińcza-Nowak ◽  
Artur Kowalik ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Germline Mutation ◽  
Medullary Thyroid Cancer ◽  
Response To Therapy ◽  
American Thyroid Association ◽  
Prophylactic Thyroidectomy ◽  
Serum Calcitonin ◽  
Medullary Thyroid

Background: Multiple endocrine neoplasia type 2A (MEN2A) is a rare, hereditary syndrome resulting from a germline mutation in the RET proto-oncogene and characterized primarily by medullary thyroid cancer (MTC), pheochromocytoma (PHEO), and hyperparathyroidism. Types of RET mutation have been associated with age at onset, clinical outcomes of MTC, and the penetrance of other components. Patients classified as ‘high-risk’ by the American Thyroid Association (ATA), based on the aggressiveness of MTC and the penetrance of other components, are recommended to undergo early prophylactic thyroidectomy at age ≤ 5 years and to be screened for PHEO at age ≥ 11 years. Patients with RET codon C634R mutations have been classified as high-risk. Case presentation: The present study describes a 71-year-old woman newly diagnosed with hereditary MTC related to a RET C634R germline mutation. Her basal serum calcitonin level was high, but there was no evidence of distant metastases. Surgery revealed bilateral MTC with two metastatic lymph nodes. Because microscopic resection was incomplete and extranodal extension was observed, the patient underwent adjuvant external beam radiotherapy. Response to therapy was excellent. Follow-up after 1.5 years showed no evidence of disease or other manifestations of MEN2A. Conclusion: Despite RET C634R carriers being classified as high-risk by the ATA, this patient did not present with either distant MTC or PHEO until her seventies. To our knowledge, only one other patient has shown a similar late identification of a RET C634R mutation, but MTC could not be diagnosed because the patient was lost to follow-up. Further research is required to develop optimal protocols that could allow patients requiring prophylactic thyroidectomy to be differentiated from those who can be monitored closely without early surgery.

Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association

Thyroid ◽  
2009 ◽  
Vol 19 (6) ◽  
pp. 565-612 ◽  
Author(s):  
Richard T. Kloos (Chair) ◽  
Charis Eng ◽  
Douglas B. Evans ◽  
Gary L. Francis ◽  
Robert F. Gagel ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Medullary Thyroid Cancer ◽  
American Thyroid Association ◽  
Management Guidelines ◽  
Medullary Thyroid ◽  
Cancer Management

scholarly journals The Impact of the Extent of Surgery on the Long-Term Outcomes of Patients with Low-Risk Differentiated Non-Medullary Thyroid Cancer: A Systematic Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2316 ◽  
Author(s):  
Andreea Bojoga ◽  
Anna Koot ◽  
Johannes Bonenkamp ◽  
Johannes de Wilt ◽  
Joanna IntHout ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Medullary Thyroid Cancer ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Low Risk ◽  
American Thyroid Association ◽  
Medullary Thyroid ◽  
Thyroid Lobectomy ◽  
Extent Of Surgery ◽  
The Impact

Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61–1.96, I2 = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99–1.00, I2 = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89–1.03, I2 = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00–1.01, I2 = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.

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