Faculty Collaboration Database

Do the recent American Thyroid Association (ATA) Guidelines accurately guide the timing of prophylactic thyroidectomy in MEN2A? Surgery 2010 Dec;148(6):1302-9; discussion 1309-10

Date

12/08/2010

Pubmed ID

21134565

DOI

10.1016/j.surg.2010.09.020

Scopus ID

2-s2.0-78649974940 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: In 2009, the American Thyroid Association (ATA) published consensus guidelines for timing of prophylactic thyroidectomy (PrThy) for treatment of hereditary medullary thyroid cancer (MTC). The aim of this study was to assess whether the clinical guidelines outlined in the ATA recommendations added to the specific mutation risk level could predict the presence of MTC on final pathology.

METHODS: A retrospective study was performed of patients undergoing PrThy. We evaluated mutation-based risk levels in combination with 2009 ATA guidelines for resection.

RESULTS: Overall, 54 patients underwent PrThy between 1972 and 2009. The median age at PrThy was 11.5 years (range, 2-68). Only 4 patients (8%) underwent PrThy prior to age 5 years. Most patients with MTC (16/22, 73%) had a level C mutation, and the youngest age of MTC in a level C mutation carrier was 5 years. The youngest age of MTC in level A or B carriers was 15 years. The single factor that predicted an overall decreased risk of MTC at the time of PrThy was meeting all ATA mutation-based postponement guidelines for surgical intervention (P = .04).

CONCLUSION: ATA guidelines that includes risk assessment of RET mutation are important in predicting the presence of MTC in patients who are candidates for prophylactic thyroidectomy and in determining the timing of operative resection.

Author List

Grubbs EG, Waguespack SG, Rich TA, Xing Y, Ying AK, Evans DB, Lee JE, Perrier ND

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Carcinoma, Neuroendocrine
Child
Child, Preschool
Consensus Development Conferences as Topic
Humans
Middle Aged
Multiple Endocrine Neoplasia Type 2a
Practice Guidelines as Topic
Predictive Value of Tests
Proto-Oncogene Proteins c-ret
Risk Assessment
Societies, Medical
Thyroid Neoplasms
Thyroidectomy
United States