2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer

Abstract

We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

“…There is a considerable body of evidence that the measurement of serum CT concentrations in patients with thyroid nodules can lead to an earlier diagnosis of MTC than the exclusive use of imaging procedures and/or fine‐needle aspiration cytology (FNAC) 4, 5, 6, 7. However, there is some controversy regarding the screening of thyroid nodules with CT measurements as to whether this is a cost‐effective exercise in terms of reducing deaths 8, 9. In addition, different analytical, physiological, pharmacological and pathological factors may significantly reduce the specificity and overall accuracy of serum CT measurement 3.…”

“…Besides, the more recent AACE, AME and ETA's common document declared that routine measurement of basal CT may be useful and strongly recommended its measurement in certain high‐risk groups 14. Finally, the ATA's guidelines panel decided to not recommend either for or against routine measurement of serum CT in patients with thyroid nodules8 but recommend that physicians decide whether the technique is useful in the management of patients in their clinic 9. If CT screening is adopted it should be noted that depending on the assay used, 56%‐88% of subjects without thyroid disease usually show a CT level below the functional sensitivity, while 3%‐10% have CT levels >10 pg/mL 15, 16.…”

“…If CT screening is adopted it should be noted that depending on the assay used, 56%‐88% of subjects without thyroid disease usually show a CT level below the functional sensitivity, while 3%‐10% have CT levels >10 pg/mL 15, 16. A CT stimulation test using pentagastrin or calcium should be performed to increase sensitivity and specificity of basal CT measurement and to avoid unnecessary thyroidectomies 9. Nevertheless, pentagastrin is not available any longer.…”

Hot and malignant – a case of invasive papillary carcinoma in hyperthyroid patient with hot nodules

“…While 4–7% of adult population in the United States have a palpable thyroid nodule, only 5% of these are malignant [1]. All thyroid nodules more than 1 cm in size and those less than 1 cm in size with associated lymphadenopathy or suggestive clinical features require further evaluation to rule out malignancy [5]. The initial step in the evaluation of a thyroid nodule is measurement of serum TSH followed by thyroid radionuclide scan if the TSH is subnormal.…”

“…Malignant nodules are usually non-functioning [2]. Hyper-functioning nodules are thought to only rarely harbor malignancy and, as such, do not necessitate cytological evaluation [5]. …”