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23-03-2006 | Thyroid | Article

Thyroid nodule treatment guidelines updated

Abstract

Journal

The American Association of Clinical Endocrinologists (AACE) has released its amended medical guidelines for the diagnosis and management of thyroid nodules.

These new guidelines take into account the advances and novel strategies for the screening and treatment of thyroid nodules that have emerged since the original guidelines were created in 1996.

A panel of scientists from backgrounds as diverse as nuclear medicine, surgery, and evidence-based medicine compiled the guidelines after reviewing currently available data. The panel was convened by the AACE, the American College of Endocrinology, and the Italian Associazione Medici Endocrinologi.

The experts noted that although most patients with thyroid nodules are asymptomatic, this does not rule out a malignant lesion and it is important to review risk factors for thyroid cancer.

The panel agreed that all patients with a palpable thyroid nodule should undergo ultrasound (US) examination, while US-guided fine needle aspiration (FNA) is recommended for thyroid nodules of 10 mm in size, and only for nodules of smaller sizes than this if clinical information or US features are suspicious.

The guidelines state that thyroid FNA is a reliable and safe method of screening and that only experienced pathologists should interpret smears. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically.

For patients with low or suppressed thyroid stimulating hormone (TSH) levels, a radioisotope scan of the thyroid is a useful screening technique, states the panel.

Finally, measurements of low levels of serum TSH should be followed by measurement of free thyroxine, while high concentrations of serum TSH should prompt assessment of thyroid peroxidase antibody levels. Cystic thyroid lesions can be treated adequately by percutaneous ethanol injection and large, symptomatic goiters may be treated surgically or with radioiodine.

Concluding, the authors write in the journal Endocrine Practice: "We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders.

"These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence."