New guidelines for the management of thyroid nodules and differentiated thyroid cancer

Z. Milas, J. Shin, Kresimira Milas

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

The last 5 years witnessed publication of several multidisciplinary guidelines that address management of benign and malignant thyroid diseases. The primary goal of this review was to excerpt highlights from the most recent 2009 guidelines of the American Thyroid Association that provided recommendations for treating thyroid nodules and differentiated thyroid cancer. There is a systematic algorithm for the evaluation of thyroid nodules based on clinical history, physical examination, measurement of thyroid stimulating hormone (TSH), and neck ultrasound, which has become the preferred radiologic modality for imaging thyroid disease. Radionuclide thyroid scanning is reserved for the evaluation of patients with suppressed TSH levels. Ultrasound-guided fine needle aspiration biopsy (FNAB) is indicated for cytologic assessment of most thyroid nodules >1 cm; additional criteria are specified for FNAB of nodules 1 cm in size. Concurrent therapeutic central and lateral neck dissections remain essential to treat known cervical metastases, but prophylactic central neck dissection is controversial and should be cautiously chosen based on individual patient risk factors. Updates have been made for the use of radioactive iodine ablation and long-term surveillance for thyroid cancer recurrence, where ultrasound imaging is also important. A risk stratification paradigm is proposed to define the chance of recurrence and death from thyroid cancer, and modify treatment plans at various stages of management to the level of risk. Recommendations addressing both benign and malignant thyroid disease topics were graded according to the strength of available and published clinical evidence. Awareness of multidisciplinary recommendations for the treatment of benign and malignant thyroid diseases can enhance the practice of evidence-based medicine and provide practical tools for decisionmaking relevant to daily clinical encounters.

Original languageEnglish (US)
Pages (from-to)53-70
Number of pages18
JournalMinerva Endocrinologica
Volume36
Issue number1
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Thyroid Nodule
Thyroid Diseases
Thyroid Neoplasms
Guidelines
Neck Dissection
Thyrotropin
Fine Needle Biopsy
Recurrence
Evidence-Based Medicine
Radioisotopes
Iodine
Physical Examination
Publications
Ultrasonography
Thyroid Gland
Neck
Therapeutics
Neoplasm Metastasis

Keywords

  • Guidelines as topic
  • Iodine radioisotopes
  • Risk assessment
  • Thyroid cancer, papillary
  • Thyroid neoplasms

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

Cite this

New guidelines for the management of thyroid nodules and differentiated thyroid cancer. / Milas, Z.; Shin, J.; Milas, Kresimira.

In: Minerva Endocrinologica, Vol. 36, No. 1, 03.2011, p. 53-70.

Research output: Contribution to journalArticle

Milas, Z. ; Shin, J. ; Milas, Kresimira. / New guidelines for the management of thyroid nodules and differentiated thyroid cancer. In: Minerva Endocrinologica. 2011 ; Vol. 36, No. 1. pp. 53-70.
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