We have carefully read the letter ‘‘Comments to SEOM clinical guidelines for the treatment of thyroid cancer’’ sent on behalf of the Thyroid Cancer Committee from the Spanish Society of Endocrinology and Nutrition (SEEN). We greatly appreciate and welcome the interest shown by our colleagues in our guidelines [1] that, as the rest of the clinical SEOM guidelines in cancer, are specially focused on helping medical oncologists in management of different tumors from our field of expertise. All our guidelines are mainly designed in a brief, schematic and practical format, to be a useful clinical tool for the medical oncologist, which is a specialty focused on treatment. That is the reason why not every issue concerning each cancer subtype is covered. If this issue is not taken into account, these guidelines could be considered incomplete. We fully agree that thyroid cancer treatment should be performed necessarily in a multidisciplinary context. Since the development of our specialty, we think that medical oncologists’ contribution to multidisciplinary management of cancer has been crucial in Spain. That is the reason why we do not care leaving untouched topics. We are sure that no medical oncologist is going to work outside a multidisciplinary team, where undoubtedly all patients will be comprehensively evaluated. Regarding the first three critical considerations, we believe it is important to understand that our guide is aimed particularly, as we stated at the beginning of the article, to ‘‘incorporate the new developed strategies, that surely will have an important role especially in relapsed and refractory tumors, unsuitable for surgical or Radio-iodine treatment.’’ We would not claim our guidelines to be used as reference in the field of diagnosis or surgical treatment. These other issues have been widely covered by previous and more completes guidelines. We agree, obviously, that a radioactive iodide (RAI) thyroid scan should be performed in a suspected nodule prior to FNA to rule out a hyperfunctioning one, where surgery would not be necessary. We also agree that where we said ‘‘radiological signs of suspect’’, it would be more accurate to say ‘‘ultrasound signs of suspect’’. In relation to the third point, we agree that cytopathological interpretation of FNA samples in thyroid nodules is a critical issue, but it far exceeds the targets set in our guide. Considering the fourth comment about the indication of lobectomy in some unilateral tumors, we honestly believe that the critical consideration does not really sustain, since we clearly stated that thyroidectomy is the most common and recommended oncologic approach, and that lobectomy ‘‘can be considered’’ in exceptional cases (very low-risk patients). We also clearly pointed out that this issue is controversial. We do not think that we say anything different to what other guidelines say [2, 3]. Related to the last consideration about follow-up, we agree also that ultrasound plays a critical role in follow-up, J. Martinez Trufero (&) Servicio de Oncologia Medica, Hospital Universitario Miguel Servet, Zaragoza, Spain e-mail: jmtrufero@seom.org