American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update

Hossein Gharib, Enrico Papini, Jeffrey R. Garber, Daniel S. Duick, R. Mack Harrell, Laszlo Hegedüs, Ralf Paschke, Roberto Valcavi, Paolo Vitti, Sofia Tseleni Balafouta, Zubair Baloch, Anna Crescenzi, Henning Dralle, Andrea Frasoldati, Roland Gärtner, Rinaldo Guglielmi, Jeffrey I. Mechanick, Christoph Reiners, Istvan Szabolcs, Martha A. Zeiger & 2 others Michele Zini, AACE/ACE/AME Task Force on Thyroid Nodules

Research output: Contribution to journalReview article

Abstract

Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate- and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME).

Original languageEnglish (US)
Article numberA001
JournalEndocrine Practice
Volume22
DOIs
StatePublished - May 1 2016
Externally publishedYes

Fingerprint

Thyroid Nodule
Endocrinology
Practice Management
Fine Needle Biopsy
Ultrasonography
Guidelines
Neoplasms
Therapeutics
Endocrinologists
Thyroxine
Genetic Markers
Healthy Volunteers
Thyroid Gland
Ethanol
Hot Temperature
Immunohistochemistry
Pregnancy
Injections

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. / Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R.; Duick, Daniel S.; Harrell, R. Mack; Hegedüs, Laszlo; Paschke, Ralf; Valcavi, Roberto; Vitti, Paolo; Balafouta, Sofia Tseleni; Baloch, Zubair; Crescenzi, Anna; Dralle, Henning; Frasoldati, Andrea; Gärtner, Roland; Guglielmi, Rinaldo; Mechanick, Jeffrey I.; Reiners, Christoph; Szabolcs, Istvan; Zeiger, Martha A.; Zini, Michele; AACE/ACE/AME Task Force on Thyroid Nodules.

In: Endocrine Practice, Vol. 22, A001, 01.05.2016.

Research output: Contribution to journalReview article

Gharib, H, Papini, E, Garber, JR, Duick, DS, Harrell, RM, Hegedüs, L, Paschke, R, Valcavi, R, Vitti, P, Balafouta, ST, Baloch, Z, Crescenzi, A, Dralle, H, Frasoldati, A, Gärtner, R, Guglielmi, R, Mechanick, JI, Reiners, C, Szabolcs, I, Zeiger, MA, Zini, M & AACE/ACE/AME Task Force on Thyroid Nodules 2016, 'American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update', Endocrine Practice, vol. 22, A001. https://doi.org/10.4158/EP161208.GL
Gharib, Hossein ; Papini, Enrico ; Garber, Jeffrey R. ; Duick, Daniel S. ; Harrell, R. Mack ; Hegedüs, Laszlo ; Paschke, Ralf ; Valcavi, Roberto ; Vitti, Paolo ; Balafouta, Sofia Tseleni ; Baloch, Zubair ; Crescenzi, Anna ; Dralle, Henning ; Frasoldati, Andrea ; Gärtner, Roland ; Guglielmi, Rinaldo ; Mechanick, Jeffrey I. ; Reiners, Christoph ; Szabolcs, Istvan ; Zeiger, Martha A. ; Zini, Michele ; AACE/ACE/AME Task Force on Thyroid Nodules. / American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. In: Endocrine Practice. 2016 ; Vol. 22.
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abstract = "Thyroid nodules are detected in up to 50 to 60{\%} of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate- and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME).",
author = "Hossein Gharib and Enrico Papini and Garber, {Jeffrey R.} and Duick, {Daniel S.} and Harrell, {R. Mack} and Laszlo Heged{\"u}s and Ralf Paschke and Roberto Valcavi and Paolo Vitti and Balafouta, {Sofia Tseleni} and Zubair Baloch and Anna Crescenzi and Henning Dralle and Andrea Frasoldati and Roland G{\"a}rtner and Rinaldo Guglielmi and Mechanick, {Jeffrey I.} and Christoph Reiners and Istvan Szabolcs and Zeiger, {Martha A.} and Michele Zini and {AACE/ACE/AME Task Force on Thyroid Nodules}",
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T1 - American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update

AU - Gharib, Hossein

AU - Papini, Enrico

AU - Garber, Jeffrey R.

AU - Duick, Daniel S.

AU - Harrell, R. Mack

AU - Hegedüs, Laszlo

AU - Paschke, Ralf

AU - Valcavi, Roberto

AU - Vitti, Paolo

AU - Balafouta, Sofia Tseleni

AU - Baloch, Zubair

AU - Crescenzi, Anna

AU - Dralle, Henning

AU - Frasoldati, Andrea

AU - Gärtner, Roland

AU - Guglielmi, Rinaldo

AU - Mechanick, Jeffrey I.

AU - Reiners, Christoph

AU - Szabolcs, Istvan

AU - Zeiger, Martha A.

AU - Zini, Michele

AU - AACE/ACE/AME Task Force on Thyroid Nodules

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate- and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME).

AB - Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate- and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME).

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