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Grace Segall Eli Lilly and Company, Indianapolis, IN, USA

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Ravinder Singh Eli Lilly and Company, Indianapolis, IN, USA

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Min-Hua Jen Eli Lilly and Company, Indianapolis, IN, USA

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Isaac Sanderson Adelphi Real World, Bollington, UK

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Alex Rider Adelphi Real World, Bollington, UK

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Katie Lewis Adelphi Real World, Bollington, UK

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Urpo Kiiskinen Eli Lilly and Company, Indianapolis, IN, USA

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). Germline RET mutations are present in up to 10% of patients with apparently sporadic MTCs ( 5 , 10 ). European Society for Medical Oncology (ESMO) guidelines recommend that screening for RET mutations should be strongly considered in all patients with

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Minoru Kihara Departments of Surgery, Kobe, Japan

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Akira Miyauchi Departments of Surgery, Kobe, Japan

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Hiroshi Yoshida Research, Kuma Hospital, Kobe, Japan

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Osamu Yamada Departments of Surgery, Kobe, Japan

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Hiroo Masuoka Departments of Surgery, Kobe, Japan

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Tomonori Yabuta Departments of Surgery, Kobe, Japan

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Takuya Higashiyama Departments of Surgery, Kobe, Japan

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Mitsuhiro Fukushima Departments of Surgery, Kobe, Japan

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Yasuhiro Ito Departments of Surgery, Kobe, Japan

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Kaoru Kobayashi Departments of Surgery, Kobe, Japan

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Akihiro Miya Departments of Surgery, Kobe, Japan

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What Is Known about This Topic? • To date, there is only one report of a double RET mutation, i.e. V804M/Y806C, in a patient with the MEN 2B phenotype. • Previous in vitro studies have suggested that these double mutations are on the same

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Marine Sitbon Pharmacy Department, Hospital Saint-Louis APHP, Paris, France

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Porhuoy Chou Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Seydou Bengaly Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Brigitte Poirot Department of Molecular Oncology, Saint-Louis Hospital (AP-HP), Université Paris Cité INSERM U 944, CNRS UMR 7212, Paris, France

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Marie Laloi-Michelin Department of Internal Medicine, Hospital Lariboisière APHP, Paris, France

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Laure Deville Pharmacy Department, Hospital Saint-Louis APHP, Paris, France

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Atanas Pachev Radiology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Ahouefa Kowo-Bille Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Clement Dumont Medical Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Cécile N Chougnet Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Established facts Paraneoplastic Cushing’s syndrome is dangerous and can be life-threatening. There are few results regarding the efficacy of RET inhibitor treatment in medullary thyroid carcinoma (MTC) with RET mutation

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R. Elisei Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy

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M. Alevizaki Endocrine Unit, Department of Medical Therapeutics, Athens University School of Medicine, Athens, Greece

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B. Conte-Devolx Department of Endocrinology, La Timone Hospital, Aix Marseille University, Marseille, France

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K. Frank-Raue Endocrine Practice, Molecular Laboratory, Heidelberg, Germany

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V. Leite Department of Endocrinology, Portuguese Institute of Oncology and CEDOC, Faculty of Medical Sciences, Lisbon, Portugal

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G.R. Williams Molecular Endocrinology Group, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK

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determined to exclude secondary hyperparathyroidism (QOE = ++; SOR = score 1). (c) If the RET mutational status cannot be obtained before surgery, the 24-hour urinary catecholamine and metanephrine measurements should be necessarily performed to exclude

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Thomas Karrasch Department of Internal Medicine III, Giessen University Hospital, Giessen

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Saskia M. Herbst Center for and Institute of Human Genetics, University of Regensburg, Regensburg, Germany

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Ute Hehr Center for and Institute of Human Genetics, University of Regensburg, Regensburg, Germany

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Andreas Schmid Department of Internal Medicine III, Giessen University Hospital, Giessen

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Andreas Schäffler Department of Internal Medicine III, Giessen University Hospital, Giessen

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.Tyr826Ser as predisposing RET variant. Patients with a compound heterozygosity of an established pathogenic RET mutation in combination with this novel variant seem to be at a higher risk of developing FMTC. The malignant risk of patients carrying

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Simona Censi Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Elisabetta Cavedon Familial Tumor Unit, Veneto Institute of Oncology, (IOV)-IRCCS, Padua, Italy

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Sara Watutantrige-Fernando Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Susi Barollo Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Loris Bertazza Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Jacopo Manso Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Maurizio Iacobone Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy

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Davide Nacamulli Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Francesca Galuppini Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Gianmaria Pennelli Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Caterina Mian Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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patients carrying different somatic RET mutations or RET wild type, and with RET-mutated cell lines (Fig.  3 ). Fig. 2. Histological and immunohistochemical features of the present case. a Thyroid follicles were documented within the lesion and

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Ségolène Hescot Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France

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Julien Masliah-Planchon Department of Genetics, Institut Curie, Paris, France

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Pauline du Rusquec Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France

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Célia Dupain Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France

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Maud Kamal Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France

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Vincent Servois Department of Radiology, Institut Curie, Paris, France

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Ivan Bieche Department of Genetics, Institut Curie, Paris, France

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Medullary thyroid carcinoma (MTC) is a rare but aggressive thyroid tumor, with 25% of hereditary and 75% of sporadic forms. RET mutations are found in 98% of hereditary MTC and in 55% of sporadic MTC ( 1 ). The most frequent somatic RET

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Renata Alencar Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil

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Daniel Barretto Kendler Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil

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Fernanda Andrade Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil

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Carla Nava Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil

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Daniel Bulzico Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil

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Cencita Cordeiro de Noronha Pessoa Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil

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Rossana Corbo Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil

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Fernanda Vaisman Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil

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diagnosis (54.8 vs. 44.4 years), had larger tumors as well as more frequently metastatic disease and higher calcitonin levels. The presence of a RET mutation showed no significance in this analysis. Table 2. Factors associated with progressive

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Carles Zafon Department of Endocrinology, Hospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona

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Juan J. Díez Department of Endocrinology and Nutrition, Hospital Ramón y Cajal
Department of Medicine, University of Alcalá de Henares, Madrid

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Juan C. Galofré Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
IdiSNA (Instituto de investigación en la salud de Navarra), Pamplona, Spain

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David S. Cooper Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

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less complete thyroid surgery may fail to address fully the primary site of disease [ 69 ]. The Question of Prophylactic Thyroidectomy The specific RET mutation enables us to intervene in multiple endocrine neoplasia type 2 patients with a

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Else Marie Opsahl Section of Breast and Endocrine Surgery, Department of Oncology, Oslo University Hospital, Oslo, Norway
Institute of Clinical Medicine, University of Oslo, Oslo, Norway

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Lars Andreas Akslen Section for Pathology, Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway
Department of Pathology, Haukeland University Hospital Bergen, Bergen, Norway

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Ellen Schlichting Section of Breast and Endocrine Surgery, Department of Oncology, Oslo University Hospital, Oslo, Norway

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Turid Aas Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway

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Katrin Brauckhoff Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway

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Anne Irene Hagen Department of Breast and Endocrine Surgery, St. Olavs University Hospital, Trondheim, Norway

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Alf Frimann Rosenlund Section of Breast and Endocrine Surgery, Department of Surgery, University Hospital of North Norway, Tromsø, Norway

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Eva Sigstad Department of Pathology, Oslo University Hospital, Oslo, Norway

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Krystyna K. Grøholt Department of Pathology, Oslo University Hospital, Oslo, Norway

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Lovise Mæhle Department of Medical Genetics, Oslo University Hospital, Oslo, Norway

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Lars Fredrik Engebretsen Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
Department of Medical Genetics, St. Olavs University Hospital, Trondheim, Norway

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Lars H. Jørgensen Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway

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Jan Erik Varhaug Department of Clinical Science, University of Bergen, Bergen, Norway

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Trine Bjøro Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway

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values at OUH < 2.1 and < 3.1 pmol/L and at HUH < 1.6 and < 2.2 pmol/L in females and males, respectively. In the present study, 3.0 pmol/L was used as the cutoff value for both sexes. RET mutation analysis followed international standards, using

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