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We read with interest the article by Learoyd et al¹ concerning genetic testing for multiple endocrine neoplasia, type 2 (MEN 2). We generally agree with the conclusion of this article, but hold a different opinion in regard to the following. The authors state that genetic screening for RET proto-oncogene mutations in MEN 2 is a powerful diagnostic tool and that RET mutation carriers older than 6 years of age should undergo thyroidectomy immediately.

We investigated the spectrum of RET mutations among patients with MEN 2, familial medullary thyroid carcinoma (FMTC), and sporadic medullary thyroid carcinoma (MTC).² Mutations in nucleotide sequences encoding 1 of 3 specific cysteine residues in the extracellular domain of RET protein were found in 37 of the 38 MEN 2A families and 3 of the 4 FMTC families examined. A mutation at codon 918 was found in the germline DNA of all 5 patients with MEN 2B . . . [Full Text of this Article]

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