American Thyroid Association Guidelines for Thyroid Nodules and Cancer

Less is More: Comparing the 2015 and 2009 American Thyroid Association Guidelines for Thyroid Nodules and Cancer:



Thyroid , Vol. 0, No. 0.

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Author information

Brian W. Kim,¹ Wina Yousman,² Wei Xiang Wong,³ Cheng Cheng,⁴ and Elizabeth A. McAninch¹

¹Division of Endocrinology, Diabetes, and Metabolism, Rush University Medical Center, Chicago, Illinois.

²Department of Physiology, University of Arizona, Tucson, Arizona.

³Department of Internal Medicine, University of Arizona, Tucson, Arizona.

⁴Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.

Address correspondence to:

Brian W. Kim, MD

Associate Professor of Medicine

Rush University Medical Center

1735 W Harrison Street

Cohn 316

Chicago, IL 60612

E-mail: Brian_W_Kim@Rush.edu

ABSTRACT

Background: The American Thyroid Association (ATA) has recently revised its guidance pertaining to thyroid nodules and follicular cell-derived thyroid cancer. The 2015 guidelines are massive in both scope and scale, with changes in the organizational approach to risk stratification of nodules and cancer, as well as multiple sections covering new material. This review highlights the major structural and organizational changes, focusing attention on the most dramatically changed recommendations, that is, those recommendations that clinicians will find striking because they call for significant divergence from prior clinical practice.

Summary: The revised approach to thyroid nodule risk stratification is based on sonographic pattern, with an emphasis on pattern rather than growth in the long-term surveillance of nodules. Accumulating data have also been incorporated into an updated risk stratification scheme for thyroid cancer that increases the size of the low-risk pool, in part because low-volume lymph nodal metastases are now considered low risk. The most fundamentally altered recommendation is that lobectomy might be considered as the initial surgical approach for follicular cell-derived thyroid cancers from 1 to 4 cm in size.

Conclusions: The underlying theme of the 2015 ATA guidelines is that "less is more." As these new recommendations are adopted, fewer fine-needle aspiration biopsies will need to be done, less extensive surgeries will become more common, less radioactive iodine will be used either for treatment or for diagnostics, and less stimulated thyroglobulin testing will be done. Mastery of these guidelines will help clinicians know when it is reasonable to do less, thus providing responsibly individualized therapy for their patients.

Supplementary Material

Supplementary Table1

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