ATA revised guidelines for management of patients with thyroid nodules, differentiated thyroid cancer

New information since initial guideline publication in 2006 prompted the ATA revisions.

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.