Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Thyroid: official journal of the American Thyroid Association (Impact Factor: 3.84). 11/2009; 19(11):1167-214. DOI: 10.1089/thy.2009.0110
Source: PubMed

ABSTRACT Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines.
Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force.
The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease.
We created evidence-based recommendations in response to our appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.

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Available from: David S Cooper, Aug 18, 2015
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    • "Such indeterminate FNACs occur in about 20% of FNACs and are due to the fact that the diagnostic criteria of follicular thyroid cancer (FTC), which depend on capsular or vascular invasion, cannot be detected by cytology. Therefore, such patients have to undergo diagnostic thyroid surgery not to overlook malignancy in about 20% of indeterminate cases (Cooper et al., 2009; Gharib et al., 2010; Paschke et al., 2011) or 5–10% or 20–30% of AUS or FLUS cases, respectively (Baloch et al., 2008). The most important differential diagnoses in this FNAC category are: distinction between FTC and follicular variant of papillary thyroid cancer (fvPTC) and follicular adenoma (FA) and adenomatous nodules (Gharib et al., 2010; Paschke et al., 2011), whereas the less frequent differential diagnosis of PTC is often possible by cytology criteria alone. "
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