2009 free full access; Thyroid Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Canc

ABSTRACT		ChooseTop of pageABSTRACT <<[A1] Thyroid Nodule Guide...[B1] Differentiated Thyro...[C1] DTC: Long-Term Manag...[D1] What are Directions ...AcknowledgmentsDisclaimerDisclosure StatementReferencesCITING ARTICLES

Background: 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.

Methods: 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.
Results: 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.

Conclusions: 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.

Thyroid nodules are a common clinical problem. Epidemiologic studies have shown the prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men living in iodine-sufficient parts of the world (1,2). In contrast, high-resolution ultrasound (US) can detect thyroid nodules in 19–67% of randomly selected individuals with higher frequencies in women and the elderly (3). The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer which occurs in 5–15% depending on age, sex, radiation exposure history, family history, and other factors (4,5)....cont'd