New Evidence-Based Thyroid Nodule Guidelines

Newswise — 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.

AACE was the first major endocrine society to publish thyroid nodule guidelines for endocrine practice in 1996. 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.

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.

"I applaud the leadership of AACE for recognizing that advances and ongoing controversies in the diagnosis and management of thyroid nodules warranted an up-to-date document to improve thyroid care. Accordingly, a team of experts were selected to develop these guidelines, formulating a clear and concise state-of-the-art, evidence-based approach to thyroid nodules, addressing areas of controversy," said Task Force Co-Chair and AACE Past-President, Hossein Gharib, M.D., Professor of Medicine at Mayo Clinic College of Medicine in Rochester, Minnesota. "We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, nuclear medicine specialists, radiologists, and internists whose practice includes management of patients with thyroid disorders. These guidelines are thorough and practical, offering reasoned and balanced recommendations based on the best available evidence."

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."

"The publication of these guidelines is intended to benefit physicians whose practice is focused on patients with thyroid disease," comments AACE President, Bill Law, Jr., M.D. "I am grateful to the Task Force for their extraordinary, tireless efforts in contributing to and shaping these guidelines. I remain confident that not only members of AACE and AME, but other physicians as well as our patients, will benefit from these updated recommendations for medical practice."

AACE is a professional medical organization with more than 5,300 members in the United States and 84 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

For an electronic version of the guidelines please visit http://www.aace.com/pub/guidelines/ or for further information visit AACE Online at http://www.aace.com.