title: Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer.
abstract: BACKGROUND
  Given the uncertainties regarding thyroid nodule assessment and management, physicians require systematically and transparently developed recommendations. This systematic review assesses the quality and consistency of the recommendations of international clinical practice guidelines (CPGs) for the diagnosis and management of thyroid nodules and cancer to assist physicians in making appropriate recommendations.
  
  
  METHODS
  The CPGs on the management of thyroid nodules and cancer published before June 2013 were retrieved. All the reviewed guidelines were in English. Four reviewers independently assessed the rigor of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated.
  
  
  RESULTS
  Ten eligible guidelines were included: nine had been developed by professional organizations, and the remaining guideline was endorsed by an independent regional body. Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Guidelines scored highest on the measurement of 'scope and purpose' (≥61.1% for eight CPGs) and lowest on the measurement of 'applicability' (≤38.5% for five CPGs). The overall quality ranged from 3.0 to 6.25 on a seven-point scale on the AGREE-II tool. Most CPG recommendations on the management of thyroid cancer were relatively consistent. Guidelines varied regarding the indication of fine-needle aspiration for thyroid nodules, as well as in their suggestions for postoperative radioiodine ablation.
  
  
  CONCLUSIONS
  Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of thyroid nodules and cancer.
authors.affiliation: Center for Evidence-based Health Care, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.
authors.forename: Tsai-Wei
authors.initials: TW
authors.lastname: Huang
authors.forename: Jun-Hung
authors.initials: JH
authors.lastname: Lai
authors.forename: Mei-Yi
authors.initials: MY
authors.lastname: Wu
authors.forename: Shiah-Lian
authors.initials: SL
authors.lastname: Chen
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
mesh_terms: D006801:Humans; D017410:Practice Guidelines as Topic; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000628:therapy