Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.
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.
The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. dscooper@jhmi.edu
David S
DS
Cooper
Gerard M
GM
Doherty
Bryan R
BR
Haugen
Bryan R
BR
Hauger
Richard T
RT
Kloos
Stephanie L
SL
Lee
Susan J
SJ
Mandel
Ernest L
EL
Mazzaferri
Bryan
B
McIver
Furio
F
Pacini
Martin
M
Schlumberger
Steven I
SI
Sherman
David L
DL
Steward
R Michael
RM
Tuttle
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008198:Lymph Nodes / Q000473:pathology; D009333:Neck; D010808:Physical Examination; D011379:Prognosis; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States
D007457:Iodine Radioisotopes