Presentation of results and recommendations

Table 1 presents the organization of the Task Force’s results, recommendations, and definitions. Readers of the print version are referred to the page number for information about specific topics, recommendations, and definitions. The location key can be used if viewing the guidelines in a file or web page. Each location key is unique and can be copied into the Find or Search functions to rapidly navigate to the section of interest. Specific recommendations and definitions are presented as bulleted points in the main body of this scholarly guidelines dialog. Table 2 presents a guide to the abbreviations used.

 Table 1. Organization of Medullary Thyroid Carcinoma Guidelines, Recommendations, and Definitions

^aIf viewing these guidelines on the Web, or in a File, copy the Location Key to the Find or Search Function to navigate rapidly to the desired section.
MTC, medullary thyroid carcinoma; R, recommendations; D, definitions; MEN, multiple endocrine neoplasia; FMTC, familial medullary thyroid carcinoma; Ct, calcitonin; PHPT, primary hyperparathyroidism; FNA, fine-needle aspiration; DT, doubling time; CEA, carcinoembryonic antigen.

Table 2. Definitions Used for Medullary Thyroid
Cancer Management Guidelines

^aMay include intensity-modulated radiation therapy.

Administration

The ATA Executive Council selected a MTC Guidelines Task Force chairman using criteria that included MTC clinical experience and the absence of dogmatically held views in areas of recognized controversy. A Task Force was selected based on clinical expertise to include representation of endocrinology, genetics, pediatrics, nuclear medicine, surgery, oncology, and clinical laboratory testing. The Task Force additionally included experts from both North America and Europe, and all members disclosed potential conflicts of interest. Guidelines funding was derived solely from the general funds of the ATA and Thyroid Cancer Survivors’ Association, Inc. (ThyCa) through an unrestricted educational grant and were devoid of commercial support.

The Task Force considered how patients with MTC or a genetic predisposition for the disease are encountered, diagnosed, and treated. In this framework, a series of flow diagrams was created and revised, and a list of questions were developed and assigned to individual Task Force members to answer utilizing the published literature and expert opinion when relevant. Based on these documents a preliminary Guideline and a series of Recommendations were made and then critically reviewed and modified by the full Task Force. The level of evidence to support the Recommendations was categorized and reviewed. Finally, the full Task Force again critically reviewed the entire Guideline and Recommendations through several iterations and arrived at a document of consensus. In most cases the consensus was unanimous while in some cases there were disparate views held by a minority of panel members; the most significant of which are noted in this document. The final document is the product of face-to-face meetings in Phoenix, Arizona, October 12, 2006; Columbus, Ohio, November 11, 2006; and Toronto, Ontario, June 2, 2007; and multiple electronic communications and telephone conference calls. The final document was approved by the ATA Board of Directors, and officially endorsed (in alphabetical order) by: American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Endocrine Surgery Committee, American Association of Clinical Endocrinologists (AACE), American Association of Endocrine Surgeons (AAES), American College of Endocrinology (ACE), Asia and Oceanic Thyroid Association (AOTA), British Association of Endocrine and Thyroid Surgeons (BAETS), British Association of Head and Neck Oncologists (BAHNO), Canadian Society of Otolaryngology—Head and Neck Surgery (CSOHNS), The Endocrine Society (ENDO), European Society of Endocrinology (ESE), European Society of Endocrine Surgery (ESES), European Thyroid Association (ETA), International Association of Endocrine Surgeons (IAES), Latin American Thyroid Society (LATS), and the Ukrainian Association of Endocrine Surgeons (UAES).

Literature review and evidence-based medicine

Relevant articles were identified by searching PubMed MEDLINE at Pubmed (NLM) using the following search terms: (medullary carcinoma) OR (medullary thyroid cancer) OR (medullary thyroid carcinoma) OR (RET) OR (calcitonin) which yielded 30,095 articles on March 10, 2007. Limiting the search to include ‘‘humans’’; and ‘‘randomized controlled trials’’ or ‘‘meta-analysis’’ from (medullary carcinoma) OR (medullary thyroid cancer) OR (medullary thyroid carcinoma) yielded 12 articles, of which 8 were relevant and they were reviewed in detail by the Task Force. In addition to these articles, numerous additional relevant articles, book chapters, and other materials were also supplied by Task Force members, including works published after the initial search. Published works were utilized to devise this Guideline as referenced.

The Task Force categorized our recommendations using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality (Table 3) as was used in the ATA publication Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer (5).

Table 3. Strength of Recommendations Based on Available Evidence

Adapted from the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality.