Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Abstract

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.

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

“…However, US is more easily accessible and cheaper than other imaging modalities, and was determined to be the most sensitive method for assessing cervical LNM 25, 26. Therefore, US performed by an experienced ultrasonographer is considered, by most clinicians and by the American Thyroid Association, as the screening and surveillance imaging modality of choice for detecting LLNM 27. Although USgFNAC was showed to be the most specific and accurate imaging modality to detect cervical LNM 25, most studies report that USgFNAC has a relatively lower sensitivity than US, and the false‐negative rate of USgFNAC could be as high as 45–52% 28, 29.…”

Thyroid nodules and evaluation of thyroid cancer risk

“…However, the clinical priority in the initial management of a thyroid nodule is to evaluate its thyroid cancer risk to guide decision regarding thyroidectomy 12 . Thyroid cancer occurs in 5–15% of nodules 2 . Approximately 90% of all thyroid cancers are differentiated thyroid cancer, 85% of which are papillary cancer 2 .…”

“…Thyroid cancer occurs in 5–15% of nodules 2 . Approximately 90% of all thyroid cancers are differentiated thyroid cancer, 85% of which are papillary cancer 2 .…”

“…multiple endocrine neoplasia type 2 or MEN2) and a history of head and neck or whole body irradiation 2 . Incidental focal thyroid uptake on flurodeoxyglucose positron emission tomography (FDG PET) imaging is associated with about 33% risk of thyroid cancer which may be more aggressive 2 , 4 .…”

“…On the other hand, a higher serum TSH is associated with an increased risk of cancer in a thyroid nodule 5 , 6 . While the cost‐effectiveness of routine serum calcitonin measurement is debatable given the low incidence of medullary thyroid cancer, serum calcitonin level should be measured if there is a family history of medullary cancer or MEN2 2 , 3 .…”