Article

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: 2.6). 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.

0 Bookmarks
 · 
444 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients. Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis. Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%. Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.
    International Journal of Endocrinology 01/2015; 2015:1-7. · 1.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A globus sensation is one of the most common complaints in otolaryngologic clinics, and laryngopharyngeal reflux is the most common cause. However, thyroid nodules also can cause globus symptoms. The purpose of this study was to identify the characteristics of thyroid nodules that cause globus. We selected patients prospectively with a single thyroid nodule on ultrasonograms. Patients with other causes of globus symptoms were excluded using questionnaires, fiber optic laryngoscopic examinations, and a psychiatric screening tool. In total, 175 patients were enrolled. Patients were divided into two groups according to globus symptoms. Ultrasonographic characteristics and clinicopathological parameters were compared between the groups. Among various clinicopathologic and ultrasonographic parameters, size and horizontal location of the thyroid nodule showed significant differences between the groups. Nodules larger than 3 cm and those located anterior to the trachea had a tendency to cause globus symptoms. Regarding horizontal location, nodules that all parts were located anterior to the trachea showed a higher tendency to cause globus symptoms than nodules that only some parts were located anterior to the trachea. In conclusion, thyroid nodules with specific size and location can cause globus symptoms, and this finding can be indicated in patient counseling. Also, conservative treatments or thyroidectomy may be helpful in relieving patients' globus symptoms.
    01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The exact frequency of non-diagnostic ultrasound-guided fine-needle aspiration (USFNA) is unknown. Clinical guidelines suggest repeating USFNA of these nodules. However, there is no specific recommendation or evidence on how and when this re-aspiration should be done. We aim to describe the approaches considered by endocrinologists to yield the highest likelihood of a satisfactory sample in solid thyroid nodules. A cross-sectional survey of The Endocrine Society (TES) and the American Thyroid Association members was conducted between October and December 2012. A total of 694 surveys were returned, 648 (93.4 %) from TES. The responders were equally divided between private and academic settings and had a high degree of expertise. Thirty-nine percent of respondents estimated the frequency of non-diagnostic USFNA to be above 10 %. For its management, 311 (46 %) recommended repeating USFNA in 1-3 months. For a second non-diagnostic USFNA, 216 (31 %) recommend surgery. The most common approaches to increase the diagnostic yield were (1) use of suction with USFNA, 18 % and (2) changing the targeted area of biopsy within the nodule, 18 %. Few considered the patients' preferences as an important driver for the management of non-diagnostic USFNA. Finally, a molecular test for bypassing non-diagnostic USFNA was regarded as the most needed strategy for future research. Variability exists in the management of non-diagnostic USFNA and strategies to increase the diagnostic yield. Testing the suggested strategies in clinical trials and understanding patient's preferences should be supported by guideline panels and funding agencies.
    Endocrine. 02/2015;

Full-text (2 Sources)

Download
119 Downloads
Available from
May 26, 2014