Background: 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 Gr...

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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 nodules are a frequent finding on neck sonography. Most nodules are benign; therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. Since 2009, many professional societies and investigators have proposed ultrasound-based risk stratification systems to identify nodules that warrant biopsy or sonographic follow-up. Because some of these systems were founded on the BI-RADS® classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.

ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee

American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update

During the past few decades, the incidence of thyroid cancer has increased substantially in many countries, including the USA. The rise in incidence seems to be attributable both to the growing use of diagnostic imaging and fine-needle aspiration biopsy, which has led to enhanced detection and diagnosis of subclinical thyroid cancers, and environmental factors. The latest American Thyroid Association (ATA) practice guidelines for the management of adult patients with thyroid nodules and differentiated thyroid cancer differ substantially from the previous ATA guidelines published in 2009. Specifically, the problems of overdiagnosis and overtreatment of a disease that is typically indolent, where treatment-related morbidity might not be justified by a survival benefit, now seem to be acknowledged. As few modifiable risk factors for thyroid cancer have been established, the specific environmental factors that have contributed to the rising incidence of thyroid cancer remain speculative. However, the findings of several large, well-designed epidemiological studies have provided new information about exposures (such as obesity) that might influence the development of thyroid cancer. In this Review, we describe the changing incidence of thyroid cancer, suggest potential explanations for these trends, emphasize the implications for patients and highlight ongoing and potential strategies to combat this growing clinical and public health issue.

The changing incidence of thyroid cancer

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60109-9.pdf

Progress in molecular-based management of differentiated thyroid cancer

Background The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7·5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. A study employing more sensitive 13 MHz scanners has not been conducted so far.



Materials and methods  Six hundred and thirty-five consecutive patients (33% female, 67% male, mean 56·7 years) presenting for a preventive health check up underwent ultrasound screening of the thyroid gland (Siemens Acuson Antares, 13 MHz-linear scanner, B-mode and Power mode) and measurement of the basal TSH (thyroid stimulating hormone) value. Size and degree of vascularization of the thyroid gland and of nodules were determined and analysed retrospectively.



Results  In 432 of 635 patients, thyroid nodules could be detected with an increasing incidence with age, in 338 without goiter. Mean thyroid size was 12·3 mL for women and 20·5 mL for men correlating strongly with body weight. Fifty-three percentage of the nodules were smaller than 5 mm. Incidence of thyroid dysfunction was only 4%. No cancerous lesions could be found.



Conclusions  Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning. Our study underlines the clinical significance of iodine deficiency and should renew the discussion on routine iodine supplementation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2362.2009.02162.x

Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.

Ziel: Beurteilung einer umfassenden internistischen Ultraschalluntersuchung im Vergleich zur Ganzkorper-MRT hinsichtlich kardiovaskularer Risikofaktoren, metabolischem Syndrom, maligner Tumoren und anderer therapeutisch relevanter Befunde. Material und Methoden: 833 konsekutive Patienten (19 – 93 J., m 56,6 J.) erhielten Sonografie (hirnzufuhrende Gefase, Schilddruse, Abdomen und Herz) und MRT-Untersuchung (Ganzkorper-MR-Angiografie, MRT Kopf, Thorax, Abdomen, virtuelle Koloskopie). Die Analyse erfolgte retrospektiv anhand der schriftlichen Befunde. Ergebnisse: In der Detektion fruher arteriosklerotischer Veranderungen (Intima-media-Verdickung, nicht stenosierende Plaques, 33 % der Pat.) sowie der Steatosis hepatis als wichtiger Parameter des metabolischen Syndroms (20,4 %) war die Sonografie der MRT deutlich uberlegen. Maligne Tumoren waren selten (1,4 %) und meist im Abdomen gelegen. MRT und Sonografie waren gleichwertig in der Detektion der abdominellen Tumoren und kleiner Leberherde. Ausschlieslich im MRT darstellbar waren intrakranielle Befunde, maligne intrathorakale Befunde sowie Kolonpolypen. Schlussfolgerung: Hinsichtlich der Detektion fruher Arteriosklerose sowie des metabolischen Syndroms erwies sich die Sonografie uberlegen. In der Darstellung tumoroser Veranderungen des Bauchraums waren die Methoden gleichwertig. Die Ganzkorper-MRT mit virtueller Koloskopie entdeckt zusatzlich krankhafte Veranderungen des Gehirns, des Thoraxraums sowie Kolonpolypen.

A. Galach

Papers

Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.

Stellenwert der Sonografie im Rahmen präventiver Untersuchungen im Vergleich zur Ganzkörper-MRT – eine retrospektive Untersuchung bei 833 Patienten