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Papaleontiou M, Haymart MR. Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: Addressing the uncertainties and challenges. Best Pract Res Clin Endocrinol Metab 2020; 34:101363. [PMID: 31786102 PMCID: PMC7242146 DOI: 10.1016/j.beem.2019.101363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thyroid nodules and thyroid cancer have become increasingly common worldwide. When discovered during pregnancy, they pose unique diagnostic and therapeutic challenges for both the treating physician and the patient. The benefits of treatment should be carefully weighed against risks that may adversely impact maternal and fetal health. In this review, we present current knowledge and controversies surrounding the management of thyroid nodules and thyroid cancer in pregnancy, in the post-partum period and during preconception planning.
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Affiliation(s)
- Maria Papaleontiou
- Medicine, Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health System, North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm 453S, Ann Arbor, MI 48109, USA.
| | - Megan R Haymart
- Medicine, Divisions of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, Department of Internal Medicine, University of Michigan Health System, North Campus Research Complex, 2800 Plymouth Rd., Bldg. 16, Rm 408E, Ann Arbor, MI 48109, USA.
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Conzo G, Musella M, Corcione F, Depalma M, Stanzione F, Della-Pietra C, Palazzo A, Napolitano S, Pasquali D, Milone M, Agostino-Sinisi A, Ferraro F, Santini L. Role of Preoperative Adrenergic Blockade with Doxazosin on Hemodynamic Control during the Surgical Treatment of Pheochromocytoma: A Retrospective Study of 48 Cases. Am Surg 2020. [DOI: 10.1177/000313481307901125] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Authors evaluated the effects of selective adrenergic blockade by means of doxazosin on blood pressure in 48 patients operated on for pheochromocytoma by a multicenter retrospective study. Age, tumor size, surgical approach, and operative time were analyzed as predictive factors of intraoperative hypertensive crises. Forty-eight patients underwent adrenalectomy—four open surgery and 44 laparoscopic surgery—for pheochromocytoma of adrenal glands from 1998 to 2008 after preoperative administration of doxazosin. Perioperative cardiovascular status modifications and surgical medium- and long-term outcomes were analyzed. There was no mortality, conversion rate was 4.5 per cent, and morbidity rate was 8.3 per cent. Intraoperative hypertensive crises (180/ 90 mmHg or higher) were observed in 14.5 per cent (seven of 48) of patients and were treated pharmacologically with no aftermath. None of the examined variables influenced the occurrence of intraoperative hypertensive episodes. Postoperative hypotension (lower than 90/60 mmHg) was observed in four of 48 patients (8.3%) and was treated by crystalloids and hydrocortisone. In the surgical treatment of pheochromocytoma, the preoperative adrenergic blockade by doxazosin does not prevent intraoperative hypertensive crises. Nevertheless, in our series, they were of short duration and were not associated with major cardiovascular complications. Perioperative hemodynamic instability was managed bypreoperative pharmacological treatment, allowing low morbidity.
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Affiliation(s)
- Giovanni Conzo
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
| | - Mario Musella
- Department of Surgery, Orthopedics, Trauma and Emergency, University of Naples “Federico II,” Naples, Italy; the
| | - Francesco Corcione
- Department of General and Laparoscopic Surgery, Monaldi Hospital, Naples, Italy; the
| | - Maurizio Depalma
- Department of General and Specialistic Surgery, Cardarelli Hospital, Naples, Italy; the
| | - Francesco Stanzione
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
| | - Cristina Della-Pietra
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
| | - Antonietta Palazzo
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
| | - Salvatore Napolitano
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
| | - Daniela Pasquali
- Division of Endocrinology, Second University of Naples, Naples, Italy
| | - Marco Milone
- Department of Surgery, Orthopedics, Trauma and Emergency, University of Naples “Federico II,” Naples, Italy; the
| | | | - Fausto Ferraro
- Anesthesiology and Intensive Care, Second University of Naples, Naples, Italy
| | - Luigi Santini
- Department of Anesthesiologic, Surgical and Emergency Science, VII Division of General Surgery Second University of Naples, Naples, Italy; the
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Mathiesen JS, Nielsen SG, Rasmussen ÅK, Kiss K, Wadt K, Hermann AP, Nielsen MF, Larsen SR, Brusgaard K, Frederiksen AL, Godballe C, Rossing M. Variability in Medullary Thyroid Carcinoma in RET L790F Carriers: A Case Comparison Study of Index Patients. Front Endocrinol (Lausanne) 2020; 11:251. [PMID: 32411094 PMCID: PMC7198720 DOI: 10.3389/fendo.2020.00251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Previous studies have suggested that the variability in age of onset and aggressiveness of medullary thyroid carcinoma (MTC) in patients with multiple endocrine neoplasia type 2A (MEN 2A) carrying the same REarranged during Transfection (RET) mutation may be caused by additional RET germline variants or somatic variants. Methods: This study was a retrospective case comparison study of all MEN 2A index patients (n = 2) with the RET L790F germline mutation in Denmark. Whole blood and MTC tissue were analyzed for RET germline variants and other somatic variants (>500), respectively. Results: Patient 1 presented with MTC (T1aN1bM0) at age 14 years, while patient 2 presented with MTC (T1bN0M0) at age 70 years. No germline RET germline variants nor other variants were found to explain this MTC variability. Conclusions: We could not confirm the previously reported finding of a somatic RET variant as likely responsible for the early onset and aggressiveness of MTC in a RET germline mutation carrier. Also, we found no RET germline variants that could explain the MTC variability among our index patients. We did, however, identify a somatic FLT3 R387Q variant with an unknown potential as genetic modifier. Further large-scale studies are needed to investigate genetic modifiers in RET L790F carriers.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- *Correspondence: Jes Sloth Mathiesen
| | - Søren Grønlund Nielsen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karin Wadt
- Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Klaus Brusgaard
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Christian Godballe
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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Tingi E, Kyriacou A, Verghese L. Recurrence of phaeochromocytoma in pregnancy in a patient with multiple endocrine neoplasia 2A: a case report and review of literature. Gynecol Endocrinol 2016; 32:875-880. [PMID: 27808580 DOI: 10.1080/09513590.2016.1236242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited condition with a prevalence of one in 40 000 individuals. It causes the development of tumours in endocrine glands, such as medullary thyroid cancer, pheochromocytomas, as well as primary hyperparathyroidism. MEN 2A in pregnancy is very rare with only 29 cases reported in the literature. The presence of pheochromocytoma is a rare cause of hypertension during pregnancy with an incidence of 0.007% of all pregnancies. This has severe implications on both mother and the foetus. This case report describes a 22-year-old nulliparous Caucasian woman with known MEN2A syndrome, who underwent thyroidectomy for medullary thyroid carcinoma in childhood and excision of left sided pheochromocytoma at the age of 19. She was found to have a recurrence of pheochromocytoma in the right adrenal gland during pregnancy at 16 weeks of gestation and was oddly normotensive. Catecholamine effects were blocked with phenoxybenzamine and she delivered by an uneventful elective caesarean section at 36 weeks gestation. She underwent a laparoscopic right adrenalectomy six weeks postpartum, followed by lifelong corticosteroid replacement.
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Affiliation(s)
- Efterpi Tingi
- a Specialist Registrar in Obstetrics and Gynaecology, St. Mary's Hospital , Manchester , UK
| | - Angelos Kyriacou
- b Consultant in Endocrinology and Diabetes, Salford Royal Hospital , Manchester , UK
- c Diabetes & Metabolism, Centre of Endocrinology , Limassol , Cyprus , and
| | - Lynda Verghese
- d Consultant in Obstetrics and Gynaecology, Wrexham Maelor Hospital , Wales , UK
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1304] [Impact Index Per Article: 144.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Maruotti GM, Sarno L, Simioli S, Castaldo G, Martinelli P. Prenatal screening and counseling for genetic disorders. J Matern Fetal Neonatal Med 2014; 26 Suppl 2:68-71. [PMID: 24059557 DOI: 10.3109/14767058.2013.829701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The carriers of the same autosomal recessive disorder are usually unaware of onset of the genetic diseases in the children even if screenings are available for many of these disorders. In this paper, we report the experience of the Prenatal Diagnosis Center of AOU Federico II and we discuss the role of the screening for beta-thalassemia (BT), cystic fibrosis (CF) and for other rare genetic disorders. MATERIALS AND METHODS We analyzed retrospectively the indication for Prenatal Diagnosis (PD) of all the couples referred to our center from January 1993 to May 2013. We divided our sample into three groups: couples at high risk for BT, for CF and for other rare genetic disorders. RESULTS From January 1993 to May 2013, we performed 1269 PD for genetic disorders. There are still couples who discovered to be carriers of BT by screening after the birth of the affected child (n = 51 (11,3%)); the majority of the people were screened for CF carrier after the birth of an affected child (n = 155 (80,7%)) or through the cascade screening (n = 28 (14,6%)). Large-scale screenings for rare genetic conditions are not available and people were screened only if they have a positive familial history. CONCLUSION Parental screening is available for many severe and rare diseases whose genetic origin is known. The proportion of patients referred for very high-risk indications increased over time with an higher demand for rare disease. An adequate counseling is fundamental to identify women at risk for having affected child. Screening, counseling and PD of genetic diseases is a complex matter and needs for a continuous update.
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Abstract
Background The American Thyroid Association (ATA) and more recently the European Thyroid Association (ETA) Guidelines on diagnosis and treatment of medullary thyroid carcinoma (MTC) have provided an excellent tool which was formerly lacking in the field of management of MTC. However, some relevant clinical questions, as the use of somatostatin analogues in the treatment of MTC and the management of pregnant patients with MTC, which were recommended in the guidelines, have been lately extensively revised. Moreover the current issue whether GLP-1 (a glucagon-like peptide-1) analogue is associated with MTC has only superficially been analyzed. Methods Publications have been retrieved in MEDLINE at Pubmed (there is no fix date retrospectively) up to October 2012 using the terms “medullary thyroid carcinoma”, “somatostatin”, “pregnancy” and “incretins”. The recommendations made by ATA and ETA were considered. Conclusions There are no data supporting the application of somatostatin analogues in the treatment of MTC, while thyroid cancer during or after pregnancy has no impact on the prognosis of disease or on the outcome of pregnancy. However, women with MEN 2 should be carefully controlled before any planned or during any unplanned pregnancy. In contrast to animal studies, there are no consistent human data supporting a stimulatory effect of GLP-1 receptor activation by liraglutide, an incretin mimetic, on calcitonin levels, though establishment of a registry and further studies are required to exclude any association between GLP-1 analogue and MTC.
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Affiliation(s)
- Leonidas H Duntas
- Unit of Endocrinology, Diabetes and Metabolism, Evgenidion Hospital, University of Athens Medical School, 20 Papadiamantopoulou St,, 115 28 Athens, Greece.
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Conzo G, Circelli L, Pasquali D, Sinisi A, Sabatino L, Accardo G, Renzullo A, Santini L, Salvatore F, Colantuoni V. Lessons to be learned from the clinical management of a MEN 2A patient bearing a novel 634/640/700 mutation of the RET proto-oncogene. Clin Endocrinol (Oxf) 2012; 77:934-6. [PMID: 22500673 DOI: 10.1111/j.1365-2265.2012.04412.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sherer DM, Dalloul M, Salame G, Shah T, Serur E, Zinn HL, Abulafia O. Sonographic Findings of Medullary Thyroid Carcinoma Leading to Diagnosis of Multiple Endocrine Neoplasia Type 2a during Pregnancy. AJP Rep 2011; 1:59-64. [PMID: 23705087 PMCID: PMC3653543 DOI: 10.1055/s-0031-1280572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 03/06/2011] [Indexed: 11/18/2022] Open
Abstract
Multiple endocrine neoplasia (MEN) type 2a (Sipple's syndrome) is characterized by medullary thyroid carcinoma and pheochromocytoma, and in a smaller percentage of cases, multiglandular parathyroid hyperplasia. This autosomal-dominant syndrome is due to a mutation in the rearranged during transfection (RET) proto-oncogene located on chromosome 10cen-10q11.2 and rarely complicates pregnancy. We present an unusual case in a patient with an enlarged thyroid with sonographic findings characteristic of thyroid cancer, which led to diagnosis and subsequent management of RET proto-oncogene-positive MEN type 2a complicating pregnancy.
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Affiliation(s)
- David M Sherer
- Divisions of Maternal-Fetal Medicine and Gynecologic Oncology, Departments of Obstetrics and Gynecology and Radiology, State University of New York, Downstate Medical Center, Brooklyn, New York
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Gestational Diabetes Leading to Diagnosis and Management of Multiple Endocrine Neoplasia Type 2a. Obstet Gynecol 2010; 115:455-457. [DOI: 10.1097/aog.0b013e3181c3cace] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mutational spectrum of multiple endocrine neoplasia type 2 and sporadic medullary thyroid carcinoma in taiwan. J Formos Med Assoc 2009; 108:402-8. [PMID: 19443294 DOI: 10.1016/s0929-6646(09)60084-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/PURPOSE Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant cancer predisposition syndrome, and > 95% of MEN 2 patients carry rearranged during transfection (RET) protooncogene mutants. We aimed to elucidate the genotype and phenotype relationship of RET proto-oncogene mutations in Taiwanese subjects with medullary thyroid cancer (MTC). METHODS We genotyped the MEN-2-associated germ-line mutations by PCR-based sequencing of the RET gene. DNA was extracted from a total of 69 members from eight unrelated families with individuals affected by MTC, and from seven sporadic cases of MTC. RESULTS RET mutations were found in four MEN 2A families, all at codon 634 (one with C>R, two with C>F, and one with C>W). One MEN 2A patient carried a de novo mutation at codon 634 (C>R). In two families of MEN 2B, all carried the mutation at codon 918 (M>T). These two cases of MEN 2B were all de novo mutations. One family of familial MTC or unclassified MEN 2 carried the codon 620 (C>F) mutation. Among the seven sporadic cases of MTC, none was found to carry any mutation in hotspot exons. Only two non-synonymous variants (T278N/exon 4 and D489N/exon 7) were found in two cases. However, these two variants were not uncommon in our elderly population. CONCLUSION We found that all eight MTC patients with a family history or with the other phenotypes of MEN 2 had RET mutations, whereas no significant RET mutation was found in seven patients with isolated MTC without family history and other endocrine diseases. Molecular scanning of the RET gene in MEN 2 and MTC in Taiwanese patients probably should be limited to exons 10, 11 and 16, initially to be cost-effective.
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Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 773] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Wattanachanya L, Bunworasate U, Plengpanich W, Houngngam N, Buranasupkajorn P, Sunthornyothin S, Shotelersuk V, Snabboon T. Bilateral pheochromocytoma during the postpartum period. Arch Gynecol Obstet 2009; 280:1055-8. [DOI: 10.1007/s00404-009-1057-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 03/16/2009] [Indexed: 11/24/2022]
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Current awareness in prenatal diagnosis. Prenat Diagn 2004. [DOI: 10.1002/pd.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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