Endocrinologists Release New Guidelines for Treatment of Thyroid Nodule Guidelines

The American Association of Clinical Endocrinologists (AACE) announced the release of its medical guidelines for the diagnosis and management of thyroid nodules. The guidelines are published in the January/February 2006 issue of Endocrine Practice, a peer-reviewed journal of AACE. Find out more information about the guidelines, and a link to the electronic version of them now.

The American Association of Clinical Endocrinologists (AACE) today announced the release of its medical guidelines for the diagnosis and management of thyroid nodules. The guidelines are published in the January/February 2006 issue of Endocrine Practice, a peer-reviewed journal of AACE.

The new guidelines take into account the advances and new strategies that have occurred in the management of thyroid nodules since the original guidelines were created in 1996.

The new guidelines were developed by a panel of experts who encompass different disciplines, including endocrinology, nuclear medicine, surgery, and evidence-based medicine. The task force was convened by AACE, the American College of Endocrinology (ACE), and the Associazione Medici Endocrinologi (AME). This document is the first collaborative effort between AACE and AME. The writing committee was comprised of 11 physician members of both societies, who were intentionally selected with the objective of creating a diversely opinionated group in order to strengthen their consensus opinions.

The guidelines emphasize the importance of thyroid nodules in clinical practice. Thyroid nodules are common in the general population and they are typically discovered by palpation in 3% to 7% and by ultrasound (US) examination in 20% to 75%. “Extra” nodules are detected by ultrasound in up to 50% of patients with a single palpable thyroid nodule. The estimated annual incidence rate of 0.1% translates into approximately 300,000 new nodules that will be discovered in the U.S. this year. The overall frequency of malignancy in thyroid nodules is approximately 5%, requiring careful selection of patients for surgical treatment. The panel agreed that all patients with palpable nodules should undergo thyroid US examination and FNA. Ultrasound-guided FNA biopsy is suggested for a nodule yielding unsatisfactory aspirate on initial palpation-guided FNA; micronodules <1 cm; impalpable nodules; and for alcohol ablative therapy. The guidelines recommend that micronodules should be selected for biopsy primarily by history and ultrasound characteristics, rather than by size alone.

Features of these guidelines include 22 tables that illustrate many key recommendations; the use of evidence-based medicine (EBM) principles, linking the guidelines to the strength of recommendations and grading references for level of evidence (LOE); an emphasis on the utility of ultrasound in thyroid practice, and recommending that all patients with thyroid nodules undergo sonographic examination; an update on thyroid fine-needle aspiration (FNA) biopsy; a review of controversies in thyroxine suppressive therapy for benign nodules; issues regarding management of thyroid micronodules; the calcitonin controversy; and use of recombinant human TSH (rhTSH) in benign thyroid disease. The document also contains a useful appendix entitled “Practical Tips."

For an electronic version of the guidelines please visit http://www.aace.com/pub/guidelines.

Source: AACE/Newswise