Thyroid Association Management Guidelines Research Articles

What is the best treatment for Anaplastic Thyroid Cancer?

The LaryngoscopeEarly View Triological Society Best Practice What is the best treatment for Anaplastic Thyroid Cancer? Kareem Al-Mulki MD, Kareem Al-Mulki MD Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, U.S.A.Search for more papers by this authorRichard V. Smith MD, Corresponding Author Richard V. Smith MD [email protected] orcid.org/0000-0002-5216-6374 Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, U.S.A. Send correspondence to Richard V. Smith, MD, Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Email: [email protected]Search for more papers by this author Kareem Al-Mulki MD, Kareem Al-Mulki MD Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, U.S.A.Search for more papers by this authorRichard V. Smith MD, Corresponding Author Richard V. Smith MD [email protected] orcid.org/0000-0002-5216-6374 Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, U.S.A. Send correspondence to Richard V. Smith, MD, Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Email: [email protected]Search for more papers by this author First published: 03 May 2023 https://doi.org/10.1002/lary.30724 Editor's Note: This Manuscript was accepted for publication on April 15, 2023. The authors have no funding, financial relationships, or conflicts of interest to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. BIBLIOGRAPHY 1Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association Guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2021; 31(3): 337- 386. 2Subbiah V, Kreitman RJ, Wainberg ZA, et al. Dabrafenib and trametinib treatment in patients with locally advanced or metastatic BRAF V600-mutant anaplastic thyroid cancer. J Clin Oncol. 2018; 36(1): 7- 13. 3Hu S, Helman SN, Hanly E, Likhterov I. The role of surgery in anaplastic thyroid cancer: a systematic review. Am J Otolaryngol. 2017; 38(3): 337- 350. 4Kwon J, Kim BH, Jung HW, Besic N, Sugitani I, Wu HG. The prognostic impacts of postoperative radiotherapy in the patients with resected anaplastic thyroid carcinoma: a systematic review and meta-analysis. Eur J Cancer. 2016; 59: 34- 45. 5Baek SK, Lee MC, Hah JH, et al. Role of surgery in the management of anaplastic thyroid carcinoma: Korean nationwide multicenter study of 329 patients with anaplastic thyroid carcinoma, 2000 to 2012. Head Neck. 2017; 39(1): 133- 139. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer.

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Since the guidelines for the management of ATC by the American Thyroid Association were first published in 2012, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, and researchers on published evidence relating to the diagnosis and management of ATC. Methods: The specific clinical questions and topics addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of the Task Force members (authors of the guideline). Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, targeted/systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues, including end of life. The guidelines include 31 recommendations and 16 good practice statements. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of ATC. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with ATC.

The combination of ultrasound patterns and superb microvascular imaging of ATA (2015) guidelines in the differentiation of benign and malignant thyroid nodules

The study included 197 thyroid nodules which were confirmed by fine-needle aspiration cytology or histopathologic examination. All nodules were graded with malignancy risk stratification of thyroids nodule accordingto the 2015 American Thyroid Association (ATA) management guidelines. Both color Doppler flow imaging (CDFI) and superb microvascular imaging (SMI) were used to classify blood flows of thyroid nodules according to Adler′s grading criteria. Morphologic and distribution features of blood flow were also observed by monochrome(mSMI). The optimal threshold drawing from ROC curve and diagnostic efficacy of single and combinative modality were calculated. The results showed that mSMI was more sensitive to detect blood flow of thyroid nodules than other Doppler techniques (P 0.05). But the specficity and accuracy of combinative modality ATA+ mSMI was significantly higher than that of ATA or mSMI alone (P<0.05). (Chin J Endocrinol Metab, 2017, 33: 845-848) Key words: Thyroid nodules; Malignancy risk stratification of thyroid nodule; Superb microvascular imaging

Pathological findings in 377 patients with differentiated thyroid cancer in a single centre

The purpose of this study is to review the pathology findings of 377 patients diagnosed with differentiated thyroid cancer (DTC) in a single centre over a period of six years. Retrospective review of all total and near-total thyroidectomies (TT and NTT) performed in a single institution. Clinical records were accessed for patient demographic data and clinical characteristics. Patients with a histopathologic diagnosis of DTC were grouped in incidental DTC and non-incidental DTC groups and TNM staging was used. 1465 thyroidectomies were included. The M:F ratio was 1:2.9. 377/1465 patients had a histologic diagnosis of DTC (26%). T1b group (n=227) had a statistically significant higher number of cases, where tumor invaded the capsule, tumor extending extrathyroidally, tumor invading the blood vessels compared to T1a group (n=64) (p=0.001 for all three variables). T1a group had a statistically significant higher number of papillary conventional variant of DTC and more unifocal tumors (p=0.045 and p=0.004 respectively). In the non-incidental DTC group (n=79), there were 29 patients (37%) in T1a category and 16 of them had a unifocal papillary DTC. 16/79 of patients (20%) operated for DTC had a subcetrimetric, unifocal papillary DTC. According to the 2106 American Thyroid Association (ATA) Management Guidelines, these patients could potentially have been treated with a lobectomy alone. Patients in T1b category present more aggressive histologic features and should undergo multi-disciplinary team discussion to decide optimal surgical treatment.

Radioiodine ablation with 1,850 MBq in association with rhTSH in patients with differentiated thyroid cancer

The aim of this study was to evaluate the efficacy of post-operative radioiodine ablation with 1,850 MBq after recombinant human thyrotropin (rhTSH) administration in patients with differentiated thyroid carcinoma (DTC). We also aimed to assess the prognostic role of several patient features on the outcome of ablation. We retrospectively analyzed data from a total of 125 patients with DTC who underwent post-operative radioiodine ablation with 1,850 MBq of ¹³¹I after preparation with rhTSH. One injection of 0.9 mg rhTSH was administered on each of two consecutive days; ¹³¹I therapy was delivered 24 h after the last injection, followed by a post-therapy whole-body scan. Successful ablation was assessed 6-12 months later and defined as an rhTSH-stimulated serum thyroglobulin (Tg) level ≤1.0 ng/ml and a normal neck ultrasound. Patients were stratified according to the American Thyroid Association (ATA) Management Guidelines for Differentiated Thyroid Cancer. Successful ablation was achieved in 82.4 % of patients, with an ablation rate of 95.1 % in low-risk patients and 76.2 % in intermediate-risk patients. Analyzing the correlation between ablation outcome and patient characteristics, we found a statistically significant association between failure to ablate and class of risk based on ATA guidelines (p = 0.025) and a stimulated Tg value at ablation of above 5 ng/ml (p < 0.001). The use of 1,850 MBq post-operative radioiodine thyroid remnant ablation in association with rhTSH is effective for low- and intermediate-risk patients. Moreover, in our study, we found a statistical correlation between failure to ablate and class of risk based on ATA guidelines for DTC and a stimulated Tg value at ablation.

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC. Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop. The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations. These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.

The 2009 American Thyroid Association Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer: Progress on the Road from Consensus- to Evidence-Based Practice

In the current issue of Thyroid, the American Thyroid Association (ATA) offers us its ‘‘Revised Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer’’ (1). The first edition of these guidelines appeared in 1996 (2), and the revised version was published a decade later (3). That was only 3 years ago, so many of us are likely to wonder: ‘‘Is it already time for a new guidelines?’’ In our opinion, the answer is a resounding ‘‘Yes!’’ Clinical practice guidelines—in general—are a controversial issue (4), and there has been ample discussion of their limitations and the potential risks associated with their use. This discussion is appropriate and often productive, but the fact remains that clinical guidelines are here to stay. The task forces that elaborate them provide an enormous service to busy clinicians by systematically and scrupulously sifting through the massive amount of scientific evidence that accumulates each year, weighing the evidence, and offering their recommendations. Who among us would be willing to take on this task alone? And is there any assurance that the individual approach would guarantee greater objectivity? The ATA’s decision to update its recommendations earlier, rather than later, is clearly laudable, as is the decision to broaden the base of the task force to include experts from outside the United States, as well as those who are involved in activities not exclusively related to the thyroid disease. A closer look at the 2009 guidelines shows that this approach has produced concrete results. In the updated guidelines for the management of thyroid nodules, two important aspects have been reconsidered and dealt with more extensively. The first involves the clinical and ultrasound criteria for performing fine-needle aspiration biopsy (FNAB). Great effort has gone into the development of recommendations regarding the size of thyroid nodules that require FNAB (along with their sonographic and clinical features). Information has been meticulously extracted from the literature and organized into a table that shows each recommendation with its strength-of-evidence rating. There are also important updates on the interpretation of FNAB findings. Here, along with the traditional, four-category classification system (nondiagnostic, malignant, indeterminate, and benign)—which continues to be the preferred approach—the task force also presents the expanded classification that emerged in 2008 from the National Cancer Institute’s Thyroid Fine-Needle Aspiration State of the Science Conference, which included six categories: nondiagnostic or unsatisfactory, benign, follicular lesion of undetermined significance, suspicious for a follicular neoplasm, suspicious for malignancy, and malignant (5). No recommendation for or against this new system is made, but—interestingly—in the new algorithm for the work-up of patients with one or more nodules (Fig. 1), the four-category classification has been expanded to include a ‘‘suspicious for malignancy’’ category. This approach is in keeping with the British classification (6), which is currently the most widely used in Europe. As for the initial management of differentiated thyroid carcinoma, important additions have been made to the sections on optimal surgical management and radioiodine (RAI) remnant ablation. In the former, greater emphasis has been placed on the importance of neck ultrasound in preoperative staging. The sonographic features suggestive of metastatic lymph nodes in the neck are presented in detail, and the authors note that preoperative ultrasound identifies suspicious cervical lymphadenopathy in about 20–31% of patients and furnishes information that changes the surgical strategy in up to 20% of cases. As for initial treatment, effort has been dedicated to defining an optimal surgical strategy. For nodules with biopsy-proven malignancy, total thyroidectomy is recommended, and the indications for lobectomy have been restricted to small (<1 cm), unifocal lesions. In accordance, completion thyroidectomy is recommended for all incidentally discovered thyroid malignancies (except those described above). All this brings the ATA’s approach closer into line with practices in Europe (7). There is also very important news on surgical approaches to loco-regional lymph node disease. An ad hoc committee composed of endocrinologists, head and neck surgeons, and endocrine surgeons specifically reviewed the topic and

The Updated American Thyroid Association Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer: A Surgical Perspective

The new ATA Guidelines are a welcome ‘‘upgrading’’ of the initial work published in 2006, made necessary by the ever-changing evidence from new studies with compelling data and high quality methodology. The role of clinical research is to allow us to rationalize and refine our practices for the benefit of our patients: ‘‘Use of the best information, thus minimizing bias and opinion, is the key element that separates ethical medical practitioners from quacks and charlatans’’ (1). This was the role of the task force in reviewing this new information, evaluating its scientific quality and its clinical implications, and ‘‘digesting’’ it into clear, precise, state-ofthe-art guidelines. New evidence concerning the surgical management of thyroid carcinoma has allowed the task force to refine their recommendations in this latest version of the Guidelines. Concerning total thyroidectomy versus lobectomy, the new Guidelines have refined the indications with more precise wording, in part based on data from a recent study of more than 50,000 patients that showed significantly improved recurrence and survival rates after thyroidectomy as opposed to lobectomy for tumors larger than 1 cm (2). This new highquality evidence has changed Recommendation 26 from ‘‘for most patients with thyroid cancer’’ to ‘‘for patients with thyroid cancer larger than 1 cm, the initial procedure should be a near-total or total thyroidectomy.’’ This is clear and evidence based and closes the debate between total thyroidectomy and lobectomy for thyroid carcinoma. Another major modification in the new Guidelines concerns the central compartment (level VI) neck dissection for papillary thyroid carcinoma. The current guidelines are more explicit in the distinction between prophylactic neck dissection (for patients clinically and radiologically N0) and therapeutic neck dissection (for patients cN1) and their respective indications. Recommendation 27a and 28 together state that central and lateral neck dissection should be performed for patients with clinically involved central or lateral neck nodes. This clear recommendation is based on accumulated evidence that therapeutic neck dissection may improve loco-regional control, decrease the need for repeated treatment with radioiodine, and may improve survival. Prophylactic neck dissection poses a problem. The risk to benefit ratio is difficult to evaluate given current evidence and conflicting data. There is no level I evidence that prophylactic central compartment neck dissection improves loco-regional control or disease-specific survival (3). Prophylactic central compartment neck dissection was shown in one study to increase the proportion of disease-free patients as documented by unmeasurable thyroglobulin levels postoperatively (4), but other similar studies have failed to show this advantage. There seem to be, nonetheless, advantages to performing a prophylactic central compartment neck dissection, and the new Guidelines have included a lengthier discussion with more data concerning its risks and benefits. The new Guidelines clearly state that intraoperative inspection of the central compartment is not a sensitive procedure for detecting metastatic nodes, a notion that is not new (5) and that exists for other head and neck cancers as well, but that seems to not have had any practical consequences for a number of surgeons. The limits of ultrasound detection in the central compartment are also clearly stated and are related to the small size of metastatic nodes; the difficult access to the region due to its small size, adjacent bones, and trachea; and the operatordependent nature of ultrasound itself. Lymph node staging using sentinel node biopsy has not been validated for thyroid cancer. It is apparent that currently the best procedure for obtaining a precise nodal staging is prophylactic lymph node dissection. The advantage of precise staging for low-risk patients has been shown in a recent study of patients with tumors less than 2 cm: the decision for adjuvant treatment with radioiodine was modified by the presence or absence of lymph node metastases for 30% of the 82 patients with pT1 tumors (6). Prophylactic central neck dissection may reveal more aggressive tumors than suspected, upstaging some patients (about 15% of the T1 tumors in the above study) and providing evidence in favor of radioiodine therapy for these selected cases. On the other hand, radioiodine was avoided for another 15% of the cases in the above study, due to negative pathology on analysis of the central compartment neck dissection. Avoiding radioiodine in low-risk patients avoids excess risk such as alterations in salivary and gonadal function or radio-induced cancers. According to the new Guidelines, radioiodine may or may not be indicated for patients with T1 or T2 tumors (Table 5 and

American Thyroid Association Guidelines for Management of Medullary Thyroid Cancer: An Adult Endocrinology Perspective

ThyroidVol. 19, No. 6 Editorials and CommentaryAmerican Thyroid Association Guidelines for Management of Medullary Thyroid Cancer: An Adult Endocrinology PerspectiveDouglas W. BallDouglas W. BallSearch for more papers by this authorPublished Online:5 Jun 2009https://doi.org/10.1089/thy.2009.0147AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySonographic predictors of aggressive behavior in medullary thyroid carcinomasAsian Journal of Surgery, Vol. 45, No. 1Innate and Adaptive Immunity Linked to Recognition of Antigens Shared by Neural Crest-Derived Tumors31 March 2020 | Cancers, Vol. 12, No. 4Mozobil® (Plerixafor, AMD3100), 10 years after its approval by the US Food and Drug Administration18 February 2019 | Antiviral Chemistry and Chemotherapy, Vol. 27CXCR4/CXCR7/CXCL12 axis promotes an invasive phenotype in medullary thyroid carcinoma7 November 2017 | British Journal of Cancer, Vol. 117, No. 12Signaling pathways in medullary thyroid carcinoma: therapeutic implicationsInternational Journal of Endocrine Oncology, Vol. 3, No. 4Survivin and XIAP: two valuable biomarkers in medullary thyroid carcinoma4 February 2016 | British Journal of Cancer, Vol. 114, No. 4Clinical Aspects of Medullary Thyroid Carcinoma20 September 2016Timing and extent of thyroid surgery for gene carriers of hereditary C cell disease—a consensus statement of the European Society of Endocrine Surgeons (ESES)3 December 2013 | Langenbeck's Archives of Surgery, Vol. 399, No. 2Thyroid and Parathyroid Surgery11 November 2013Enfermedades de la glándula tiroidesProphylactic thyroidectomy for MEN 2-related medullary thyroid carcinoma based on predictive testing for RET proto-oncogene mutation and basal serum calcitonin in ChinaEuropean Journal of Surgical Oncology (EJSO), Vol. 39, No. 9Benefit-Risk Balance of Reoperation for Persistent Medullary Thyroid CancerAnnals of Surgery, Vol. 257, No. 4Is basal ultrasensitive measurement of calcitonin capable of substituting for the pentagastrin-stimulation test?25 January 2013 | Clinical Endocrinology, Vol. 78, No. 3Incidentally Discovered Medullary Thyroid Cancer: Diagnostic Strategies and TreatmentThe Journal of Clinical Endocrinology & Metabolism, Vol. 96, No. 5Biomarker-Based Risk Stratification for Previously Untreated Medullary Thyroid CancerThe Journal of Clinical Endocrinology & Metabolism, Vol. 95, No. 6Role of Ultrasonography in Thyroid DiseaseOtolaryngologic Clinics of North America, Vol. 43, No. 2 Volume 19Issue 6Jun 2009 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Douglas W. Ball.American Thyroid Association Guidelines for Management of Medullary Thyroid Cancer: An Adult Endocrinology Perspective.Thyroid.Jun 2009.547-550.http://doi.org/10.1089/thy.2009.0147Published in Volume: 19 Issue 6: June 5, 2009PDF download

Skin Metastases from Anaplastic Thyroid Carcinoma

ThyroidVol. 16, No. 5 Images in ThyroidologySkin Metastases from Anaplastic Thyroid CarcinomaMarco Capezzone, Paolo Giannasio, Domenico De Sanctis, Pasquale Bellitti, Pasquale Vena, Eugenia Morabito, and Rocco BrunoMarco CapezzoneSearch for more papers by this author, Paolo GiannasioSearch for more papers by this author, Domenico De SanctisSearch for more papers by this author, Pasquale BellittiSearch for more papers by this author, Pasquale VenaSearch for more papers by this author, Eugenia MorabitoSearch for more papers by this author, and Rocco BrunoSearch for more papers by this authorPublished Online:6 Jun 2006https://doi.org/10.1089/thy.2006.16.513AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Skin Metastases from Anaplastic Thyroid Carcinoma." , 16(5), pp. 513–514FiguresReferencesRelatedDetailsCited byCutaneous Metastasis of Head and Neck Malignancy1 January 2015 | International Journal of Head and Neck Surgery, Vol. 6, No. 2American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer Robert C. Smallridge, Kenneth B. Ain, Sylvia L. Asa, Keith C. Bible, James D. Brierley, Kenneth D. Burman, Electron Kebebew, Nancy Y. Lee, Yuri E. Nikiforov, M. Sara Rosenthal, Manisha H. Shah, Ashok R. Shaha, and R. Michael Tuttle for the American Thyroid Association Anaplastic Thyroid Cancer Guidelines Taskforce6 November 2012 | Thyroid, Vol. 22, No. 11Thyroid Cancer and the SkinF-18 FDG PET/CT Imaging of a Subcutaneous Scalp Metastasis From Primary Carcinoma of the ThyroidClinical Nuclear Medicine, Vol. 32, No. 2 Volume 16Issue 5May 2006 InformationCopyright 2006, Mary Ann Liebert, Inc.To cite this article:Marco Capezzone, Paolo Giannasio, Domenico De Sanctis, Pasquale Bellitti, Pasquale Vena, Eugenia Morabito, and Rocco Bruno.Skin Metastases from Anaplastic Thyroid Carcinoma.Thyroid.May 2006.513-514.http://doi.org/10.1089/thy.2006.16.513Published in Volume: 16 Issue 5: June 6, 2006PDF download