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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. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.2015 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.Haugen BR1, Alexander EK2, Bible KC3, Doherty GM4, Mandel SJ5, Nikiforov YE6, Pacini F7, Randolph GW8, Sawka AM9, Schlumberger M10, Schuff KG11, Sherman SI12, Sosa JA13, Steward DL14, Tuttle RM15, Wartofsky L16.Author information11 University of Colorado School of Medicine , Aurora, Colorado.22 Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.33 The Mayo Clinic , Rochester, Minnesota.44 Boston Medical Center , Boston, Massachusetts.55 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.66 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.77 The University of Siena , Siena, Italy .88 Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts.99 University Health Network, University of Toronto , Toronto, Ontario, Canada .1010 Institute Gustave Roussy and University Paris Sud , Villejuif, France .1111 Oregon Health and Science University , Portland, Oregon.1212 University of Texas M.D. Anderson Cancer Center , Houston, Texas.1313 Duke University School of Medicine , Durham, North Carolina.1414 University of Cincinnati Medical Center , Cincinnati, Ohio.1515 Memorial Sloan Kettering Cancer Center , New York, New York.1616 MedStar Washington Hospital Center , Washington, DC.AbstractBACKGROUND: 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 Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.RESULTS: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research.CONCLUSIONS: We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.Comment inA "new/old method" for TSH stimulation: could a third way to prepare DTC patients for (131)I remnant ablation possibly exist? [Eur J Nucl Med Mol Imaging. 2016]2015 American Thyroid Association Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer and Their Implementation in Various Care Settings. [Thyroid. 2016]Risk of malignancy in 1502 solid thyroid nodules >1 cm using the new ultrasonographic classification of the American Thyroid Association. [Endocrine. 2017]The "broken chair" in patients with differentiated thyroid cancer. [Endocrine. 2017]PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020 [Indexed for MEDLINE] Free PMC ArticleShareImages from this publication.See all images (8)Free textFIG. 1.Algorithm for evaluation and management of patients with thyroid nodules based on US pattern and FNA cytology. R, recommendation in text.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 2.ATA nodule sonographic patterns and risk of malignancy.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 3.Lymph node compartments separated into levels and sublevels. Level VI contains the thyroid gland, and the adjacent nodes bordered superiorly by the hyoid bone, inferiorly by the innominate (brachiocephalic) artery, and laterally on each side by the carotid sheaths. The level II, III, and IV nodes are arrayed along the jugular veins on each side, bordered anteromedially by level VI and laterally by the posterior border of the sternocleidomastoid muscle. The level III nodes are bounded superiorly by the level of the hyoid bone and inferiorly by the cricoid cartilage; levels II and IV are above and below level III, respectively. The level I node compartment includes the submental and submandibular nodes, above the hyoid bone, and anterior to the posterior edge of the submandibular gland. Finally, the level V nodes are in the posterior triangle, lateral to the lateral edge of the sternocleidomastoid muscle. Levels I, II, and V can be further subdivided as noted in the figure. The inferior extent of level VI is defined as the suprasternal notch. Many authors also include the pretracheal and paratracheal superior mediastinal lymph nodes above the level of the innominate artery (sometimes referred to as level VII) in central neck dissection ().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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 4.Risk of structural disease recurrence in patients without structurally identifiable disease after initial therapy. The risk of structural disease recurrence associated with selected clinico-pathological features are shown as a continuum of risk with percentages (ranges, approximate values) presented to reflect our best estimates based on the published literature reviewed in the text. In the left hand column, the three-tiered risk system proposed as the Modified Initial Risk Stratification System is also presented to demonstrate how the continuum of risk estimates informed our modifications of the 2009 ATA Initial Risk System (see Recommendation 48). *While analysis of BRAF and/or TERT status is not routinely recommended for initial risk stratification, we have included these findings to assist clinicians in proper risk stratification in cases where this information is available. FTC, follicular thyroid cancer; FV, follicular variant; LN, lymph node; PTMC, papillary thyroid microcarcinoma; PTC, papillary thyroid cancer.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 5.Clinical decision-making and management recommendations in ATA low-risk DTC patients that have undergone total thyroidectomy. R, recommendation in text.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 6.Clinical decision-making and management recommendations in ATA low risk DTC patients that have undergone less than total thyroidectomy (lobectomy or lobectomy with isthmusectomy). R, recommendation in text.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 7.Clinical decision-making and management recommendations in ATA intermediate risk DTC patients that have undergone total thyroidectomy. R, recommendation in text.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 CancerThyroid. 2016 Jan 1;26(1):1-133.FIG. 8.Clinical decision-making and management recommendations in ATA high risk DTC patients that have undergone total thyroidectomy and have no gross residual disease remaining in the neck. R, recommendation in text.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 CancerThyroid. 2016 Jan 1;26(1):1-133.Publication types, MeSH termsPublication typesPractice GuidelineResearch Support, Non-U.S. Gov'tReviewMeSH termsCell Differentiation*ConsensusEndocrinology/standards*Evidence-Based Medicine/standardsHumansMedical Oncology/standards*Predictive Value of TestsThyroid Neoplasms/epidemiologyThyroid Neoplasms/pathologyThyroid Neoplasms/therapy*Thyroid Nodule/epidemiologyThyroid Nodule/pathologyThyroid Nodule/therapy*Treatment OutcomeLinkOut - more resourcesFull Text SourcesAtypon - PDFEurope PubMed CentralPubMed CentralOther Literature SourcesSee the articles recommended by F1000Prime's Faculty of more than 8,000 leading experts in Biology and Medicine. - Faculty of 1000Cited by Patents in - The LensMedicalClinicalTrials.govThyroid Cancer - Genetic AllianceThyroid Cancer - MedlinePlus Health InformationMiscellaneousNCI CPTC Antibody Characterization Program

دستورالعمل مدیریت انجمن Association آمریکایی ۲۰۱۵ برای بیماران بزرگ‌سال مبتلا به سرطان Cancer Thyroid و and Differentiated: انجمن The آمریکایی American Guidelines Task on and Differentiated Differentiated Differentiated Differentiated Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid Thyroid

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