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

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

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To cite this article:
David S. Cooper, Gerard M. Doherty, Bryan R. Haugen, Richard T. Kloos, Stephanie L. Lee, Susan J. Mandel, Ernest L. Mazzaferri, Bryan McIver, Furio Pacini, Martin Schlumberger, Steven I. Sherman, David L. Steward, R. Michael Tuttle. Thyroid. November 2009, 19(11): 1167-1214. doi:10.1089/thy.2009.0110.

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Published in Volume: 19 Issue 11: November 4, 2009
Online Ahead of Print: October 27, 2009

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Full Text: • HTML • PDF for printing (717.1 KB) • PDF w/ links (995.7 KB)
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David S. Cooper, M.D.1 (Chair)*,
*Authors are listed in alphabetical order and were appointed by ATA to independently formulate the content of this manuscript. None of the scientific or medical content of the manuscript was dictated by the ATA.

Gerard M. Doherty, M.D.,2
Bryan R. Haugen, M.D.,3
Richard T. Kloos, M.D.,4
Stephanie L. Lee, M.D., Ph.D.,5
Susan J. Mandel, M.D., M.P.H.,6
Ernest L. Mazzaferri, M.D.,7
Bryan McIver, M.D., Ph.D.,8
Furio Pacini, M.D.,9
Martin Schlumberger, M.D.,10
Steven I. Sherman, M.D.,11
David L. Steward, M.D.,12 and
R. Michael Tuttle, M.D.13
1The Johns Hopkins University School of Medicine, Baltimore, Maryland.
2University of Michigan Medical Center, Ann Arbor, Michigan.
3University of Colorado Health Sciences Center, Denver, Colorado.
4The Ohio State University, Columbus, Ohio.
5Boston University Medical Center, Boston, Massachusetts.
6University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
7University of Florida College of Medicine, Gainesville, Florida.
8The Mayo Clinic, Rochester, Minnesota.
9The University of Siena, Siena, Italy.
10Institute Gustave Roussy, Paris, France.
11University of Texas M.D. Anderson Cancer Center, Houston, Texas.
12University of Cincinnati Medical Center, Cincinnati, Ohio.
13Memorial Sloan-Kettering Cancer Center, New York, New York.
Address correspondence to:


David S. Cooper, M.D.


Division of Endocrinology

The Johns Hopkins University School of Medicine

1830 East Monument Street Suite 333


Baltimore, MD 21287

E-mail:
Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines.

Methods: Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force.

Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease.

Conclusions: 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.

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