Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

Thyroid nodules are very common, and thyroid cancer is currently the fifth leading cancer diagnosis in women. The American Thyroid Association has led the development and revision of guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer (DTC). The most current revision was published in the January 2016 issue of the journal Thyroid. The current guidelines have 101 recommendations, with 8 figures and 17 tables that are hopefully helpful to those treating patients with thyroid nodules and cancer. The primary goals of the American Thyroid Association Guidelines Task Force were to use the current evidence to guide recommendations and yet be as helpful and practical as possible within the scope and strength of the evidence. The current review focuses on new and significantly revised recommendations that may very well change clinical practice. The author notes 3 new basic principles that have emerged in this guidelines revision: 1) the management of thyroid nodules, including the decision to perform a fine-needle aspiration biopsy as well as follow-up decision making, will be heavily influenced by the newly developed sonographic risk pattern; 2) the long-term management of DTC along with thyroid-stimulating hormone target goals will be heavily influenced by the 4 categories of “response to therapy”; and 3) the management of patients with radioactive iodine-refractory DTC will be divided into 4 basic decision-making groups: patients who should undergo monitoring, patients who should undergo directed therapies, patients who should undergo systemic therapies, and patients who should be offered entry into clinical trials. Cancer 2017;123:372–381. © 2016 American Cancer Society.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.30360

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed?

Objective:To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy.Background:Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in th

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults

Purpose Cervical lymph node metastases are recognized as a prognostic indicator only in patients age 45 years or older with papillary thyroid cancer (PTC); patients younger than age 45 years are perceived to have low-risk disease. The current American Joint Committee on Cancer staging for PTC in patients younger than age 45 years does not include cervical lymph node metastases. Our objective was to test the hypothesis that the presence and number of cervical lymph node metastases have an adverse impact on overall survival (OS) in patients younger than age 45 years with PTC. Patients and Methods Adult patients younger than age 45 years undergoing surgery for stage I PTC (no distant metastases) were identified from the National Cancer Data Base (NCDB; 1998-2006) and from SEER 1988-2006 data. Multivariable models were used to examine the association of OS with the presence of lymph node metastases and number of metastatic nodes. Results In all, 47,902 patients in NCDB (11,740 with and 36,162 without nodal me...

Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer

Thyroid cancer is the most common malignancy of the endocrine system, with an estimated incidence of 60,220 in 2013 in the United States.1 Papillary thyroid cancer represents more than 90% of all thyroid cancer cases, and is the most indolent form of the disease.2 Prognosis is excellent, with 20-year survival surpassing 90% when appropriate therapy is undertaken.3 The mainstay of treatment for papillary thyroid cancer is surgical resection.

The current American Thyroid Association (ATA) guidelines recommend total or near-total thyroidectomy for papillary thyroid cancers >1 cm.4 This recommendation was supported by an analysis of population-level data from the National Cancer Database (NCDB) by Bilimoria et al. of 52,173 patients who either underwent total thyroidectomy or lobectomy for papillary thyroid cancer between 1985 and 1998. They found that total thyroidectomy was associated with better overall survival for papillary thyroid cancers tumors ≥1 cm, whereas extent of thyroid resection did not impact survival in patients with tumors <1 cm.5 However, a subsequent analysis of 22,724 papillary thyroid cancer patients (1988–2001) from the Surveillance, Epidemiology and End Results (SEER) database showed no survival difference between thyroid lobectomy vs. total thyroidectomy.6 These conflicting findings have reopened the debate regarding the issue of extent of surgery. Others have pointed out concerns with Bilimoria et al.’s multivariable analysis, as it did not account for potentially important factors such as comorbidities, multifocality, extrathyroidal extension, and completeness of resection.7, 8

Therefore, we sought to examine the association between extent of surgery and overall survival in relation to tumor size in a more contemporary NCDB cohort (1998–2006), while adjusting for patient demographic, clinical, and pathologic factors, including those that may have been confounders in prior studies.

/pdf/extent-of-surgery-for-papillary-thyroid-cancer-is-not-58oqm58gef.pdf

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.

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Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.