AACE, AME and ETA jointly publish guidelines for diagnosis and management of thyroid nodules

Three of the world's most respected medical associations for the treatment of thyroid disease recently issued joint guidelines for the diagnosis and management of thyroid nodules. The American Association of Clinical Endocrinologists (AACE), the Associazione Medici Endocrinologi (AME) and European Thyroid Association (ETA) jointly published the guidelines online this week, and the executive summary will be published in the next issue of their respective journals.

"These updated guidelines represent a complete overhaul and revision of the previous guidelines issued by AACE-AME in 2006, with weighted, evidence-based medicine assignment," said Daniel S. Duick, MD, FACP, FACE, Past President of AACE and President-Elect of the American College of Endocrinology.  "It is the most authoritative and comprehensive document published to date on the management of thyroid nodules."

The guidelines also reflect the newly standardized AACE protocol for production of clinical practice guidelines to rate evidence level. The new guidelines emphasize ultrasonography (US) as a central component in the diagnosis of thyroid nodule and in the indication and execution of Fine-Needle Aspiration Biopsy (FNA) and recommend its widespread use for FNA assistance and guidance. The new guidelines also propose the adoption of a five-class system for cytologic reporting and interpretation (Class 1 Nondiagnostic; Class 2 Benign; Class 3 Follicular lesions; Class 4 Suspicious; Class 5 Malignant) and update information on roles of laboratory evaluation and radionuclide scanning. Levothyroxine therapy is not recommended for the management of thyroid nodules in most patients. The guidelines recognize other interventional ultrasound-guided procedures for the management of thyroid nodules such as Percutaneous Ethanol Injection in cystic nodules or future perspective options such as laser and other thermal ablation techniques in patients who have pressure symptoms and either decline surgery or are at surgical risk.

"These guidelines serve as teaching tools for endocrinologists, as they extensively describe how to conduct a US diagnostic examination and US-guided procedures and review standards for laboratory measurements and radioiodine treatment," said Roberto Valcavi, MD, FACE, Past President of AME. "The guidelines also include illustrations on a diagnostic algorithm for the thyroid nodule, a figure correlating FNA indication with US findings, and several tables summarizing practical recommendations for the diagnosis and management of thyroid nodules."

The release of these guidelines is unique, as it represents the consensus between three major endocrinology-focused associations on the diagnosis and treatment of thyroid nodules.

"These guidelines contain updated and practical information for the endocrinologists who daily manage patients with thyroid nodules.  They include useful tips on when to perform thyroid US, how to classify cytologic diagnosis, how to manage benign, suspicious, and malignant nodules, and work up and treatment of those with multinodular goiters, etc.," said Hossein Gharib, MD, MACP, MACE, Past President of AACE and the American College of Endocrinology. "We emphasize that these general recommendations may not necessarily apply to different global practices, and may have to be modified depending on the many issues including the availability of resources, economic issues, and prevalence of disease in a community or region."