{"id":4462,"date":"2022-01-26T11:52:28","date_gmt":"2022-01-26T16:52:28","guid":{"rendered":"http:\/\/staging.tiro.flywheelsites.com\/recommendations\/medullary-thyroid-cancer\/management-of-thyroid-nodules-diagnosed-as-mtc\/"},"modified":"2022-09-21T12:55:28","modified_gmt":"2022-09-21T17:55:28","slug":"surgical-management","status":"publish","type":"page","link":"https:\/\/tiro.expert\/es\/recommendations\/mtc\/surgical-management\/","title":{"rendered":"Gesti\u00f3n quir\u00fargica"},"content":{"rendered":"\t<style media=\"screen\">\n\t:root { --row-count: 4; }\n\t<\/style>\n<div class=\"clinical-outline-wrap open\">\n\t<div class=\"outline-header\">\n\t\t<p><strong>Surgical Management<\/strong><\/p>\t\t<p>Clinical Outline<\/p>\n\t<\/div>\n\n\t<div id=\"toc\">\n\t\t<div class=\"aod-opener opened\"><\/div>\n\t\t<div class=\"toc-content\"><\/div>\n\t<\/div>\n\n\t<div id=\"edu\" class=\"wp-block-group__inner-container legend\">\n\t\t<div class=\"aod-opener\"><\/div>\n\n\t\t<div class=\"table-wrap aod-content\">\n\t\t\t<div class=\"table-grid\">\n\n\t\t\t\t<div class=\"table-header table-row\">\n\t\t\t\t\t<div class=\"fixed-col\">Educational Clips from TIROxMDS<\/div>\n\n\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\" title=\"Primers in Thyroidology\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\" title=\"Journal Club Presentation\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\" title=\"Case-based Discussion (inc. roundtables)\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\" title=\"Grand Rounds Lectureship\"><\/i><\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">1. Initial Treatment: Thyroidectomy<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">2. Initial Treatment: Neck Dissection<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">A. Patients Clinically N0, Preoperatively cN0<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">B. Patients Clinically N1, Preoperatively cN1<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">3. Management of Patients With Locally Advanced or Metastatic Disease<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">A. Treatment of Locally Advanced Disease<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">B. Local Therapy for Patients with Distant Metastases<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">C. Management of Patients with Incomplete Thyroidectomy\u00a0and\/or Lymph Node Dissection Incomplete Initial Surgery<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">4. Evaluation of Patients Following Surgery Including Measurement of Ctn &amp; CEA and Scans for Workup of Rising Ctn &amp; CEA<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">A. Evaluation of Patients Following Surgery<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">B. Measurement of Doubling Times of Serum Ctn &amp; CEA to Determine Rate of Disease Progression<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t<div id=\"key\" class=\"legend\">\n\t\t\t\t<div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Primers in Thyroidology<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Journal Club Presentation<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Case-based Discussion (inc. roundtables)<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Grand Rounds Lectureship<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t<\/div>\n\t<\/div>\n\n\t<div class='outline-tab closer'><i class='fas fa-times'><\/i><\/div>\n\n\t<div id=\"areas-discord\" class=\"legend cloak\">\n\t\t<div class=\"aod-opener\"><\/div>\n\t\t<div class=\"aod-content\"><\/div>\n\t<\/div>\n\t<div class=\"logo-wrap\">\n\t\t<div class=\"widget widget_media_image\"><div class=\"widget-content\"><a href=\"\/\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"250\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png\" class=\"image wp-image-1039  attachment-full size-full\" alt=\"TIRO Thyroid International Recommendations Online monogram logo\" style=\"max-width: 100%; height: auto;\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png 250w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269-150x150.png 150w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a><\/div><\/div>\t<\/div>\n\t<div class=\"site-nav\">\n\t\t<div class=\"menu-primary-tiro-container\"><ul id=\"menu-primary-tiro\" class=\"menu\"><li id=\"menu-item-3048\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-3048\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/\" data-ps2id-api=\"true\">Care Recommendations<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4432\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4432\"><a href=\"#\" data-ps2id-api=\"true\">Differentiated Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-1987\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1987\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-evaluation-of-thyroid-nodules\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules<\/a><\/li>\n\t\t<li id=\"menu-item-1986\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1986\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-management\/\" data-ps2id-api=\"true\">Initial Management<\/a><\/li>\n\t\t<li id=\"menu-item-1983\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1983\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-staging-response-to-therapy\/\" data-ps2id-api=\"true\">Initial Staging &#038; Response to Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1984\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1984\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1985\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1985\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/use-of-rai\/\" data-ps2id-api=\"true\">Use of Radioactive Iodine<\/a><\/li>\n\t\t<li id=\"menu-item-1982\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1982\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/recurrent-persistent-disease\/\" data-ps2id-api=\"true\">Recurrent &#038; Persistent Disease<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4433\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4433\"><a href=\"#\" data-ps2id-api=\"true\">Medullary Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4465\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4465\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/initial-evaluation-of-thyroid-nodules-suspicious-of-mtc\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules Suspicious of MTC<\/a><\/li>\n\t\t<li id=\"menu-item-4467\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4467\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4862\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4862\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/evaluation-of-advanced-disease\/\" data-ps2id-api=\"true\">Evaluation of Advanced Disease<\/a><\/li>\n\t\t<li id=\"menu-item-4466\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4466\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/management-of-specific-clinical-scenarios\/\" data-ps2id-api=\"true\">Management of Specific Clinical Scenarios<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4434\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4434\"><a href=\"#\" data-ps2id-api=\"true\">Anaplastic Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4502\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4502\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/diagnostic-procedures\/\" data-ps2id-api=\"true\">Diagnostic Procedures<\/a><\/li>\n\t\t<li id=\"menu-item-4501\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4501\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/initial-staging-treatment-planning\/\" data-ps2id-api=\"true\">Initial Staging &#038; Treatment Planning<\/a><\/li>\n\t\t<li id=\"menu-item-4500\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4500\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4499\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4499\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-4498\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4498\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/end-of-life-care\/\" data-ps2id-api=\"true\">End of Life Care<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-29263\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-29263\"><a href=\"#\" data-ps2id-api=\"true\">Analysis Tools<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-29264\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-29264\"><a href=\"https:\/\/tiro.expert\/es\/ata-2025-risk-of-recurrence-calculator\/\" data-ps2id-api=\"true\">Risk of Recurrence Calculator<\/a><\/li>\n\t\t<li id=\"menu-item-20846\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20846\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/analysis-tools\/\" data-ps2id-api=\"true\">Anatomic Checklist for Thyroid Cancer<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-1990\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1990\"><a href=\"https:\/\/tiro.expert\/es\/clinical-trial-options\/\" data-ps2id-api=\"true\">Clinical Trial Options<\/a><\/li>\n\t<li id=\"menu-item-3818\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3818\"><a href=\"https:\/\/tiro.expert\/es\/tables-and-figures\/\" data-ps2id-api=\"true\">Tables &#038; Figures<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1973\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1973\"><a href=\"#\" data-ps2id-api=\"true\">Events<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4348\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4348\"><a href=\"https:\/\/tiro.expert\/es\/webinars\/\" data-ps2id-api=\"true\">Upcoming Webinars<\/a><\/li>\n\t<li id=\"menu-item-20057\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20057\"><a href=\"https:\/\/tiro.expert\/es\/past-webinars\/\" data-ps2id-api=\"true\">Past Webinars<\/a><\/li>\n\t<li id=\"menu-item-1975\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1975\"><a href=\"\/subscribe\" data-ps2id-api=\"true\">Subscribe <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1974\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1974\"><a href=\"#\" data-ps2id-api=\"true\">About TIRO<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-1977\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1977\"><a href=\"https:\/\/tiro.expert\/es\/what-is-tiro\/\" data-ps2id-api=\"true\">What is TIRO?<\/a><\/li>\n\t<li id=\"menu-item-2407\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2407\"><a href=\"https:\/\/tiro.expert\/es\/how-to-use-tiro\/\" data-ps2id-api=\"true\">How to Use TIRO<\/a><\/li>\n\t<li id=\"menu-item-1978\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1978\"><a href=\"https:\/\/tiro.expert\/es\/contact\/\" data-ps2id-api=\"true\">Contact<\/a><\/li>\n\t<li id=\"menu-item-1979\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1979\"><a href=\"https:\/\/thancguide.org\/\" data-ps2id-api=\"true\">THANC Guide <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n\t<li id=\"menu-item-1980\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1980\"><a href=\"https:\/\/thancfoundation.org\" data-ps2id-api=\"true\">THANC Foundation <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div>\t<\/div>\n<\/div>\n<div class=\"clinical-outline-mask\"><\/div>\n\n\n\n<h2 class=\"has-secondary-color has-text-color wp-block-heading\">Management Recommendations<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1. Initial Treatment: Thyroidectomy<\/h3>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ JAES \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Total thyroidectomy is recommended as initial treatment in all patients.<span id=\"926a2822-354e-4f43-be20-4a4dd8c7c43c\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unilateral sporadic MTC may be treated by thyroid lobectomy.<span id=\"ad543bff-dd5a-4c81-b8e7-74e3aed614cc\" data-items=\"[&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b4\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is recommended to:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Treat pheochromocytoma before treating MTC.<span id=\"fcdf195e-8fc2-4988-ae09-526b724d04e1\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1,2\u200b<\/sup><\/span><\/li><li>Treat hyperparathyroidism at time of thyroidectomy.<span id=\"f0f6073e-3c50-446b-a97f-4dead3ed8314\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/li><li>Perform a preoperative ultrasound of the thyroid and neck.<span id=\"e6956392-aea6-4da3-9bda-347dc046d72d\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;,&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">2. Initial Treatment: Neck Dissection<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When indicated, neck dissection should be performed by an experienced surgeon.<span id=\"2b4a434a-290f-4115-86c8-b31d42d5cb75\" data-items=\"[&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">A. Patients Clinically N0, Preoperatively cN0<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Prophylactic central neck dissection in patients cN0 on initial imaging is generally recommended, but with varying criteria and thresholds for indications.<\/p>\n\n\n\n<div id=\"aod-0\" class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-genesis-blocks-gb-accordion aod gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Prophylactic Central Neck Dissection<\/summary><div class=\"gb-accordion-text\">\n<p class=\"guidelines wp-block-paragraph\">ATA &amp; JAES vs. ESMO vs. NCCN<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>For ATA &amp; JAES, prophylactic central neck dissection is recommended in all patients.<span id=\"af42d4ae-e657-4989-8968-65ad48f03d09\" data-items=\"[&quot;3554851309&quot;,&quot;3526447921&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1,4\u200b<\/sup><\/span><\/li><li>For ESMO, prophylactic central neck dissection is recommended only if basal Ctn &gt; 20 pg\/ml.<span id=\"4e37a57f-3f84-4608-a986-17d72e90a2b7\" data-items=\"[&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/li><li>For NCCN, prophylactic central neck dissection is recommended for tumors &gt; or = 1 cm and can be considered for tumors &lt; 1 cm.<span id=\"bce3bd49-5574-49d4-a0f4-f524a4cc2ef2\" data-items=\"[&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span><\/li><\/ul>\n<\/div><\/details><\/div>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">A prophylactic lateral neck dissection is recommended ipsilaterally:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>By ESMO if basal Ctn &gt; 50 pg\/ml and bilaterally if basal Ctn &gt; 200 pg\/ml,<span id=\"72c16180-39db-4183-862c-88ed8dc1a706\" data-items=\"[&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/li><li>By ATA and JAES based on basal serum Ctn.<span id=\"8ce81ceb-26ea-43c7-b758-a9bd30767b8b\" data-items=\"[&quot;3554851309&quot;,&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1,4\u200b<\/sup><\/span><\/li><\/ul>\n\n\n\n<div id=\"aod-1\" class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-genesis-blocks-gb-accordion aod gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Prophylactic Lateral Neck Dissection<\/summary><div class=\"gb-accordion-text\">\n<p class=\"guidelines wp-block-paragraph\">ATA &amp; JAES vs. ESMO<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ATA and JAES suggest prophylactic lateral neck dissections based on basal serum Ctn levels, however no clear-cut threshold is established.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ESMO offers clear thresholds for selection of prophylactic lateral neck dissection.&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ipsilateral if Ctn &gt; 50 pg\/mL<\/li><li>Bilateral if Ctn &gt; 200 pg\/mL<\/li><\/ul>\n<\/div><\/details><\/div>\n<\/div><\/div>\n\n\n\n<h4 class=\"wp-block-heading\">B. Patients Clinically N1, Preoperatively cN1<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">A therapeutic neck dissection is recommended in patients with cN1 on initial imaging:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It is recommended to perform a central neck dissection (level VI) in all patients with metastatic nodes detected preoperatively (cN1a or cN1b).<span id=\"1e6dac81-f92e-4f0b-81ee-09361ecf5945\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;,&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Extent of central neck dissection in clinically N1 disease preoperatively:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>ESMO and NCCN recommend bilateral prophylactic level VI neck dissection.<\/li><li>ATA and JAES do not indicate whether prophylactic neck dissection of level VI should be bilateral or unilateral.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">It is recommended to perform a therapeutic ipsilateral lateral neck dissection for cN1b patients. The extent of the therapeutic lateral neck dissection differs among the guidelines:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The ATA recommends neck dissection of the involved lateral neck compartments (levels II-V).<\/li><li>The NCCN recommends a modified neck dissection (levels II-V).&nbsp;<\/li><li>The ESMO recommends neck dissection of at least levels IIA, III and IV.<\/li><li>The JAES does not have a recommendation regarding therapeutic lateral neck dissection.<\/li><\/ul>\n\n\n\n<p class=\"cloak has-lightning-background-color has-background wp-block-paragraph\">EXPERT COMMENTARY NEEDED \u2013 BY MLU comment<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A prophylactic ipsilateral lateral neck dissection may be considered in cases of high-volume or gross disease in the ipsilateral central compartment (high-volume cN1a)<span id=\"a2776910-0716-4bcd-bb9e-7eaaf30a0b8c\" data-items=\"[&quot;1033354911&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span> or based on Ctn levels and \u201cprognostic factors individually\u201d.<span id=\"8b49e8f0-8513-4901-be04-7cfd0bfcaee3\" data-items=\"[&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b4\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A prophylactic contralateral lateral neck dissection should be considered for unilateral cN1b patients if basal Ctn &gt; 200 pg\/ml.&nbsp;<\/p>\n\n\n\n<div id=\"aod-2\" class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-genesis-blocks-gb-accordion aod gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Contralateral Neck Dissection: Perform or Consider<\/summary><div class=\"gb-accordion-text\">\n<p class=\"guidelines wp-block-paragraph\">ATA vs. ESMO<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ESMO advises that this contralateral neck dissection be performed, and the ATA advises that it be considered.<\/p>\n<\/div><\/details><\/div>\n<\/div><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">3. Management of Patients With Locally Advanced or Metastatic Disease<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">A. Treatment of Locally Advanced Disease<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">For unresectable disease, EBRT\/IMRT or systemic therapy may be considered.<span id=\"89ebcd1e-2ffe-4701-8a7f-a6bee6d5f200\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1,2\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When surgery is possible, function-sparing techniques and techniques that minimize complications should be preferred when possible. EBRT\/IMRT and\/or systemic adjuvant therapies may be considered.<span id=\"59841d14-31a2-4552-8f5c-2808582b967b\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1,2\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Radical neck dissection is not recommended.<span id=\"0eb5fd5b-eb0a-4ab8-aa4f-908f91684d5d\" data-items=\"[&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Adjuvant radiation therapy to the neck Is rarely recommended by the NCCN but may be considered after grossly incomplete tumor resection after additional attempts at surgical resection have been ruled out<span id=\"77d697dd-a3a1-44af-ad36-d276513c9a89\" data-items=\"[&quot;1033354911&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span> or in the presence of extensive regional or metastatic disease after less aggressive surgery with preservation of voice and swallowing has been performed.<span id=\"fc3aa119-ff0e-4ded-890d-67f82f2cbc32\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The decision for surgery, external beam radiation therapy (EBRT) and\/or systemic therapy should be discussed in a multidisciplinary setting and the patient included in the decision-making process.<span id=\"3fc18d4d-5269-452b-8d67-b530d8df651b\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<h5 class=\"wp-block-heading\">i. Factors to Consider in the Decision<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Disease related symptoms.<\/li><li>Ability to preserve function (speech, swallowing).<\/li><li>Rate of disease progression.<\/li><li>Life expectancy and comorbidities.&nbsp;<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">B. Local Therapy for Patients with Distant Metastases<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Locoregional therapy in patients with distant metastases may be considered based on symptoms and disease progression.<span id=\"db9b0e81-64ca-45f7-a217-c3adee01b677\" data-items=\"[&quot;3554851309&quot;,&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1,3\u200b<\/sup><\/span> Function-sparing techniques are preferred. Less aggressive surgery may be appropriate, with or without EBRT and\/or systemic therapy.<span id=\"a637d1e7-7ca9-4a3d-8818-7746428c21b0\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">C. Management of Patients with Incomplete Thyroidectomy&nbsp;and\/or Lymph Node Dissection Incomplete Initial Surgery<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\">i. After Thyroid Lobectomy<\/h5>\n\n\n\n<p class=\"wp-block-paragraph\">If a germline RET mutation is found, a completion thyroidectomy and neck dissection are indicated, tailored according to the neck ultrasound and calcitonin levels, following the recommendations for initial surgery. (See initial surgery)<span id=\"4dc27a83-1a89-44d3-a58c-c8a237089372\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the absence of germline RET mutation, if the postoperative basal Ctn is undetectable and CEA is normal, only follow-up is required.<span id=\"79663646-b557-434b-8d1a-b72ece3ff3ca\" data-items=\"[&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span> Otherwise, treatment should follow recommendations for initial surgery.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">ii. After Incomplete Lymph Node Dissection<\/h5>\n\n\n\n<p class=\"wp-block-paragraph\">If the postoperative basal Ctn is detectable, the NCCN recommends performing imaging work-up, adding contrast enhanced neck, chest and liver CT if Ctn&nbsp; &gt; 150 pg\/ml. Surgery is the preferred modality for treatment of locoregional persistent disease.<span id=\"6f2cb950-78ad-4129-b11f-4b305029665a\" data-items=\"[&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">After incomplete initial neck dissection, the ATA recommends considering a repeat neck dissection only if the postoperative basal Ctn &lt; 1000 pg\/ml and five or fewer lymph nodes had been removed in the previous operation, regardless of RET mutation status.<span id=\"f655f83f-7105-49d0-997b-a45b84a11429\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">4. Evaluation of Patients Following Surgery Including Measurement of Ctn &amp; CEA and Scans for Workup of Rising Ctn &amp; CEA<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">A. Evaluation of Patients Following Surgery<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\">i. Post-surgical Follow-up Planning<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Post-operative TNM classification, extent of lymph node metastases, and postoperative serum Ctn levels should be considered in predicting outcome and planning long-term follow-up of patients treated by thyroidectomy for MTC.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">ii. Frequency of Post-surgical Ctn &amp; CEA Monitoring<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Initial assessment of Ctn and CEA serum levels should be measured 2\u20133 months postoperatively. If undetectable or within the normal range, they should be tested every 6 months for 1 year and then yearly thereafter. The likelihood of significant residual disease with an undetectable basal Ctn is very low.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the patient has MEN2 then annual screening for pheochromocytoma (MEN2B or MEN2A) and hyperparathyroidism (MEN2A) should also be performed.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">iii. Approach if elevated Ctn &lt; 150 pg\/ml<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with elevated postoperative serum Ctn levels less than 150 pg\/mL should have a physical examination and US of the neck. If these studies are negative the patients should be followed every 6 months (or 6\u201312 months NCCN) with physical examination, measurement of serum levels of Ctn and CEA, and US.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">iv. Approach if Ctn > 150 pg\/ml<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the postoperative serum Ctn level exceeds 150 pg\/mL patients should be assessed with multiple imaging procedures as required, including neck US, chest CT, contrast-enhanced MRI or three-phase contrast-enhanced CT of the liver, and bone scintigraphy and\/or MRI of the pelvis and axial skeleton.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If these initial investigations are negative, there is some discordance between guideline recommendations with regard to the appropriate tests to use in order to identify structural disease recurrence:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>FDG PET and FDOPA PET\/CT<\/strong> are not recommended to detect distant metastases.<span id=\"ceb0085c-ac50-461d-a16a-66680375d0e3\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/li><li><strong>FDG PET\/CT<\/strong> may be useful in assessing advanced disease and disease demonstrating rapid progression based on rapid calcitonin \/CEA doubling times.<span id=\"d86b1acb-6624-49a6-b041-33aab6042f99\" data-items=\"[&quot;1033354911&quot;,&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2,3\u200b<\/sup><\/span><\/li><li><strong>FDOPA PET\/CT<\/strong> has high specificity and sensitivity in MTC and may be useful in detection of small lesions that are not detected by other imaging modalities. However high cost and lack of availability represent challenges to access for patients.<span id=\"37cf734e-db6b-45cd-88dd-6b27d2690f5d\" data-items=\"[&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/li><li><strong>68Ga-DOTATATE PET<\/strong> may be considered as an additional imaging study if initial imaging is negative.<span id=\"a7655415-c3b5-4c31-b639-b465a1e2ba50\" data-items=\"[&quot;1033354911&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span><\/li><li><strong>68Ga-somatostatin analogue PET<\/strong> should be considered when feasibility of radionuclide therapy is being explored.<span id=\"2ca344e2-e161-41a1-b104-6e2a62a10229\" data-items=\"[&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">B. Measurement of Doubling Times of Serum Ctn &amp; CEA to Determine Rate of Disease Progression<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\">i. Ctn Doubling Time Calculation<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In patients with detectable serum levels of Ctn and CEA following thyroidectomy, these markers should be measured at least every 6 months to determine their doubling times.<span id=\"26dcbb32-9046-4a9d-834e-b77fc8c87c58\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span> These should be based on at least four consecutive measurements, preferably over a 2-year period.<span id=\"3a64a690-4f79-43b1-9e1b-c0865cb50e42\" data-items=\"[&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span> <\/p>\n\n\n\n<div class=\"wp-block-group cloak\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"wp-block-paragraph\">An ATA online calculator can be used for this purpose.&nbsp;<\/p>\n\n\n\n<p class=\"faux-heading has-lightning-background-color has-background has-h-5-font-size wp-block-paragraph\">&gt;&gt; insert link to ATA doubling time calculator&nbsp;<\/p>\n<\/div><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">ii. Utility of Ctn Doubling Time to Guide Systemic Therapy<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Systemic therapy should not be administered to patients with increasing serum Ctn and CEA levels but no documented metastatic disease<span id=\"d10e4db8-c95b-4563-a2b6-eb3422e5ef90\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span> or absence of structural disease progression.<span id=\"c167f869-b2b1-4ae2-8008-5a4fabb6d0d7\" data-items=\"[&quot;1033354911&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2\u200b<\/sup><\/span> Nor should systemic therapy be administered to patients with stable low-volume metastatic disease, as determined by imaging studies and serum Ctn and CEA doubling times greater than 2 years. Clinically relevant disease is rarely detected if Ctn &lt; 150pg\/ml, but the likelihood of structural disease increases as Ctn, and CEA levels rise.<span id=\"1e40b26f-9a55-46c5-985d-68898279e295\" data-items=\"[&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b3\u200b<\/sup><\/span><\/p>\n\n\n\n<h5 class=\"wp-block-heading\">iii. Exclusion of Distant Disease Prior to Repeat Neck Surgery<\/h5>\n\n\n\n<p class=\"guidelines wp-block-paragraph\">ATA \/\/ ESMO \/\/ NCCN<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Distant metastatic disease should be excluded prior to repeat neck surgery. Most guidelines<span id=\"fcc5a0a1-65b0-46a4-8d9f-e9dc10898cfd\" data-items=\"[&quot;1033354911&quot;,&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b2,3\u200b<\/sup><\/span> advocate the use of conventional imaging +\/- selective use of PET scanning (see \u2018Approach if Ctn &gt; 150 pg\/ml\u2019) in patients with persistent or recurrent MTC following thyroidectomy.<\/p>\n\n\n\n<div class=\"wp-block-media-text alignwide is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded has-violet-08-color has-subtle-background-background-color has-text-color has-background tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:30% auto\"><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg);background-position:67% 52%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg\" alt=\"selective focus photography of people sitting on chairs while writing on notebooks\" class=\"wp-image-2444 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi.jpg 1600w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-violet-08-color has-text-color\">Add TIROxMDS Webinars to Your Calendar<\/h2>\n\n\n\n<p class=\"has-violet-08-color has-text-color wp-block-paragraph\"><strong>In 2 quick steps, you can add our entire schedule of upcoming webinars to your calendar today!<\/strong> That way, you will never miss our upcoming lectures, presentations and case-based studies. Every Friday at 8:00 AM ET, we cover a new topic from published research.<\/p>\n\n\n\n<a title=\"Add to Calendar\" class=\"addeventstc\" data-id=\"wo408159\" href=\"https:\/\/www.addevent.com\/calendar\/wo408159\" target=\"_blank\" rel=\"nofollow noopener\">Add to Calendar<\/a>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center tw-mb-6 tw-sm-text-left tw-heading-border-bottom has-violet-color has-text-color has-h-3-font-size\">Upcoming Webinars<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<div class=\"wp-block-columns alignwide tw-mt-8 tiroxmds-grid tw-cols-rounded tw-cols-stack-md tw-cols-card tw-cols-card-white is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Ari Wassner, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Thyroid Function After Hemithyroidectomy in Children<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 13, 2026<\/p>\n\n\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Gabriela Brenta, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>ATA 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy &amp; Post Partum<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 20, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/r2zbrqhwblsp\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column has-accent-background-color has-background is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-violet-04-color has-text-color has-h-5-font-size\">No Webinar<\/h3>\n\n\n\n<p class=\"has-background-color has-text-color has-small-font-size wp-block-paragraph\"><strong><strong>Due to Thanksgiving (US Holiday).<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date has-violet-05-color has-text-color wp-block-paragraph\">Nov. 27, 2026<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns alignwide tw-mt-8 tiroxmds-grid tw-cols-rounded tw-cols-stack-md tw-cols-card tw-cols-card-white is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Marika Russell, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Scholarly Dialogue on Risk to the Recurrent Laryngeal Nerve with Thermal Ablation Procedures: A Reflection on Empirical Practices.<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 4, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/8qxr8bgvhxjm\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Michael Tuttle, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Moderator<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-comments\"><\/i> <strong>Tumor Board<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Cases presen<\/strong><\/strong><\/strong>ted by Dr. Andy Bauer<\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 11, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/9td6xgn8slvc\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Johnson Thomas, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Artificial Intelligence Applications in Thyroid Cancer Diagnosis: 2026 Update<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 18, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/ngl44hcwp9cn\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignwide has-media-on-the-right is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:auto 49%\"><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-text-align-center has-violet-08-color has-text-color\">Watch Past Videos<\/h2>\n\n\n\n<p class=\"has-text-align-center has-violet-08-color has-text-color wp-block-paragraph\">We record and post all prior educational webinars to our YouTube channel.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-cbcdc57d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--2\"><a class=\"wp-block-button__link has-violet-color has-white-background-color has-text-color has-background has-link-color has-border-color wp-element-button\" href=\"https:\/\/youtube.com\/playlist?list=PLKIn9wjqDMOm0DCLhGQN77tnT4MPo_Rcg\" style=\"border-color:#5b47da;border-width:3px;border-radius:100px\" target=\"_blank\" rel=\"noreferrer noopener\">Watch now<\/a><\/div>\n<\/div>\n<\/div><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg);background-position:55% 34%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg\" alt=\"Focused businessman wear headphones study online watching webinar\" class=\"wp-image-1180 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-scaled.jpg 2048w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1980x1320.jpg 1980w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-group tw-rounded has-blush-light-purple-gradient-background has-background\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">\u00cates-vous de langue maternelle fran\u00e7aise?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Notre conseil consultatif international a cr\u00e9\u00e9 une version portable de TIRO.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/04\/TIRO.expert-Traduction-en-francais-des-recommandations.docx.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-cloud-arrow-down\"><\/i> t\u00e9l\u00e9charger le PDF<\/a><\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-subtle-background-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group tw-mb-0 tw-mt-0\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<section aria-label=\"Bibliography\" class=\"wp-block-abt-bibliography abt-bibliography\" role=\"region\"><h3 class=\"abt-bibliography__heading\">References<\/h3><ol class=\"abt-bibliography__body\" data-entryspacing=\"1\" data-maxoffset=\"3\" data-linespacing=\"1\" data-second-field-align=\"flush\"><li id=\"3554851309\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">1. <\/div><div class=\"csl-right-inline\">Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. <i>Thyroid<\/i>. Published online January 2016:1-133. doi:<a href=\"https:\/\/doi.org\/10.1089\/thy.2015.0020\">10.1089\/thy.2015.0020<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1033354911\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">2. <\/div><div class=\"csl-right-inline\">Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. <i>J Natl Compr Canc Netw<\/i>. Published online December 2018:1429-1440. doi:<a href=\"https:\/\/doi.org\/10.6004\/jnccn.2018.0089\">10.6004\/jnccn.2018.0089<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1400531341\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">3. <\/div><div class=\"csl-right-inline\">Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. <i>Annals of Oncology<\/i>. Published online December 2019:1856-1883. doi:<a href=\"https:\/\/doi.org\/10.1093\/annonc\/mdz400\">10.1093\/annonc\/mdz400<\/a><\/div>\n  <\/div>\n<\/li><li id=\"3526447921\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">4. <\/div><div class=\"csl-right-inline\">Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. <i>Endocr J<\/i>. Published online 2020:669-717. doi:<a href=\"https:\/\/doi.org\/10.1507\/endocrj.ej20-0025\">10.1507\/endocrj.ej20-0025<\/a><\/div>\n  <\/div>\n<\/li><\/ol><\/section>\n<\/div><\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recomendaciones de manejo 1. Tratamiento inicial: Tiroidectom\u00eda ATA \/\/ ESMO \/\/ JAES \/\/ NCCN Se recomienda la tiroidectom\u00eda total como tratamiento inicial en todos los pacientes.1-3 El CTM espor\u00e1dico unilateral puede tratarse mediante lobectom\u00eda tiroidea.4 Se recomienda: Tratar el feocromocitoma antes de tratar el CTM.1,2 Tratar el hiperparatiroidismo en el momento de la tiroidectom\u00eda.1 Realizar una ecograf\u00eda preoperatoria del tiroides y...<\/p>","protected":false},"author":1,"featured_media":191,"parent":4459,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/template-cover.php","meta":{"_acf_changed":false,"inline_featured_image":false,"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-4462","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO Pro 5.0.5 - aioseo.com -->\n\t<meta name=\"description\" content=\"Total thyroidectomy is the surgical procedure indicated for patients. 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Initial Treatment: Thyroidectomy ATA \/\/ ESMO \/\/ JAES \/\/ NCCN Total thyroidectomy is recommended as initial treatment in all patients.\u200b1\u20133\u200b Unilateral sporadic MTC may be treated by thyroid lobectomy.\u200b4\u200b It is recommended to: Treat pheochromocytoma before treating MTC.\u200b1,2\u200b Treat hyperparathyroidism at time of thyroidectomy.\u200b1\u200b Perform a preoperative ultrasound of the thyroid and&hellip;","publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4462","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/comments?post=4462"}],"version-history":[{"count":0,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4462\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4459"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/media\/191"}],"wp:attachment":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/media?parent=4462"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}