The American Thyroid
Association released new, revised guidelines for the
diagnosis and treatment of patients with thyroid nodules and differentiated thyroid
cancer.
“The revised ATA guidelines represent another advance in the
clinical care of patients with these common problems,” David S. Cooper,
MD, chair of the taskforce and professor of medicine at Johns Hopkins
University School of Medicine, told Endocrine Today.
The ATA Guidelines Taskforce on Thyroid Nodules and Differentiated
Thyroid Cancer updated the initial management guidelines it released in 2006
because of the large number of new clinical research findings that have been
published in the last three years. The prevalence of differentiated thyroid
cancer is rapidly increasing, and thyroid nodules continue to be a common
clinical problem.
The revisions were published in the November issue of
Thyroid.
Revised guidelines
For the management of thyroid nodules, the guidelines focus on the
initial presentation, clinical and ultrasound evaluation, decision to perform
fine needle biopsy and interpretation of the results, and the management of
benign thyroid nodules.
The revised guidelines for managing thyroid cancer provide
recommendations for optimal surgical management, use of radioiodine remnant
ablation and thyroid hormone suppression therapy, long-term ultrasound
surveillance and laboratory testing.
Additionally, "we now provide recommendations for fine needle aspiration
of thyroid nodules based not on thyroid nodule size alone, but based on
ultrasound characteristics," Cooper said. "This will lead to fewer nodules
being biopsied, in my opinion."
Cooper estimated that "fewer patients will be receiving radioactive
iodine remnant ablation in the future since [the guidelines] now state that
patients with small unifocal tumors or microscopic multifocal disease should
not receive radioiodine therapy," he said.
"I have the feeling that fewer patients will be receiving radioactive
iodine remnant ablation in the future since we now state that patients with
small unifocal tumors or microscopic multifocal disease should not receive
radioiodine therapy," he said.
“Fewer patients may be receiving radioactive iodine remnant
ablation in the future because of this recommendation,” Cooper said.
Continually evolving management
Four editorials accompany the revised guidelines in Thyroid.
In his editorial, Leonard Wartofsky, MD,at the Washington
Hospital Center in Washington, DC, said these guidelines should not be
considered permanent, as new approaches to the diagnosis and treatment of
thyroid cancer will continually evolve.
“Clinicians should look forward to periodic refinements and
revisions in the decades to come that may ultimately resolve many of the
remaining controversies associated with management of both benign and malignant
tumors of the thyroid,” Wartofsky wrote. “The 2009 guidelines will be
invaluable until the next revision and we should all be extremely grateful to
the task force for this extraordinary contribution to the care of our patients
with thyroid nodules and thyroid cancer.”
Terry Davies, MD, ATA president and Florence and Theodore
Baumritter professor of medicine, Mount Sinai School of Medicine, wrote,
"Guidelines should be designed to guide, and this revision signals the
maturation of internationally well received advice on the management of
patients with potentially serious disease. Nobody should underestimate the
danger of badly managed thyroid cancer and this ATA Task Force has produced a
first class guide for practitioners." - by Jennifer Southall
Cooper DS. Thyroid. 2009;doi:10.1089=thy.2009.0110.
