Latin American Thyroid Society recommendations for the management of thyroid nodules

Abstract

Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries. Arq Bras Endocrinol Metab. 2009;53(9):1167-75 Keywords Thyroid nodule; thyroid ultrasonography; thyroid aspiration biopsy; radioactive iodine therapy resumo Vários consensos têm sido publicados acerca do diagnóstico e do tratamento de nódulos e cân-cer da tireoide. Entretanto, as recentes recomendações nem sempre são apropriadas para diferentes regiões ou países. O objetivo deste trabalho foi oferecer uma série de recomendações para a avaliação e conduta de pacientes portadores de nódulos tireoideos aplicáveis a todos os países da América Latina. O trabalho foi realizado por um comitê composto por 13 membros da Sociedade Latino-Americana de Tireoide envolvidos com pesquisa e manejo de pacientes portadores de nódulos e carcinoma diferenciado da tireoide, de diferentes centros médicos da América Latina. As recomendações foram estabelecidas, após consenso, utilizando as opiniões especializadas de cada membro e os princípios da medicina baseada em evidência. Após a primeira reunião do grupo, um primeiro documento foi elaborado e encaminhado a todos os membros para revisão. Posteriormente, o documento foi enviado aos membros da Sociedade Latino-Americana de Tireoide para avaliação, sugestões e comentários. A versão final, elaborada após refinada revisão de todos os autores, representa o estado da arte no diagnóstico e na conduta de nódulos tireoideos, aplicáveis a todos os países da América Latina.

Is Doppler ultrasound of additional value to gray-scale ultrasound in differentiating malignant and benign thyroid nodules?

“…Instead of analyzing only the performance of Doppler US for the differentiation of benign and malignant nodules, its additional contribution to GSUS was also evaluated, since the latter is always obtained and its value has been well established. In addition, the rate of malignancy (approximately 10%) is in accordance with that observed in subjects with nodular thyroid disease (1,(3)(4)(5)12,13), minimizing the probability that the predictive values obtained are under-or overestimated.…”

“…One hundred sixty of these 355 nodules were malignant. The 10 patients with indeterminate (n = 3) or ina dequate (n = 7) cytology and without available histology were at low clinical risk of malignancy (2)(3)(4)(5)(6)(7)12,13,17), and the nodules showed no growth after 24 months of follow-up.…”

“…T he current indications for fine-needle aspiration (FNA) of thyroid nodules < 10 mm are highly selective (1)(2)(3)(4)(5)(6)(7). FNA is also not necessary in the case of autonomous or cystic nodules ≥ 10 mm.…”

“…In the remaining cases, ultrasonographic characteristics of the nodule (composition, echogenicity, shape, margins, halo, calcifications) are important for the indication of FNA and for estimating the risk of malignancy. Nodule vascularity has also been proposed to be of diagnostic value, but many authors question this proposal (3,4,(8)(9)(10)(11).…”

Concordancia de la citología por punción con aguja fina para la detección de cáncer de tiroides en pediatría

“…La PAF es un método de tamizaje importante en los nódulos tiroideos y entrega información sobre riesgo de cáncer para guiar el manejo (Tabla 2). La citología tiroidea por PAF está establecida como parte de la evaluación de rutina de los nódulos tiroideos en adultos y se caracteriza por una alta precisión diagnóstica 12,13 . En pediatría, la utilidad de la PAF también ha sido demostrada 2,11 , pero su uso no se encuentra completamente aceptado.…”