Guideline-orientated Diagnosis of Thyroid Nodules
Guideline-orientated Diagnosis of Thyroid Nodules
European Endocrinology - Volume 5 Issue 1
US Endocrinology - Volume 5 Issue 1
Published: September 2009
US Endocrinology - Volume 5 Issue 1
Published: September 2009
Abstract
Thyroid nodules are very common. Their aetiology is due to the interaction between genetic and environmental factors. In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME), the American Thyroid Association (ATA) and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scales make a rapid comparison of the strength of both evidence and recommendations difficult for use in current clinical practice. Some recommendations are based mostly on expert opinion. The same recommendation may be based on different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. A survey performed during an interactive symposium at the 32nd annual meeting of the ETA in Leipzig, Germany, was carried out to investigate whether these guidelines were able to affect the divergent management strategies for thyroid nodules that have previously been documented. The thyroid nodule guidelines obviously provide useful information and recommendations for practice and have a positive impact on patient care; however, guidelines should be considered as suggestions rather than a rigid formula for practice. With further accumulating evidence, these guidelines will need revision and updating.
Keywords
Thyroid nodule, diagnosis, treatment, guidelines, evidence-based
Disclosure: The authors have no conflicts of interest to declare.
Received: 27 April 2009 Accepted: 10 July 2009
Correspondence: Ralf Paschke, III Medical Department, University of Leipzig, Ph.-Rosenthal-Str. 27, D-04103 Leipzig, Germany. E: pasr@medizin.uni-leipzig.de
Aetiology, Epidemiology and Risks
Thyroid nodules are very common. Moreover, with the increasing use of sensitive imaging techniques, an increasing proportion of thyroid nodules are now detected incidentally. A prospective study comparing clinical examination and ultrasound showed that 46% of nodules >1cm detected by ultrasound escaped detection by clinical examination. Autopsy and prospective ultrasound studies in North America detected asymptomatic thyroid nodules in 50 and 67%, respectively. A population study in Germany – a previously iodinedeficient and currently borderline iodine-sufficient country – detected thyroid nodules by ultrasound in 20% of the population 20–79 years of age. The prevalence increased with advancing age to 52 and 29%, respectively, for women and men 70–74 years of age.
According to current knowledge, the aetiology of thyroid nodules can be summarised as outlined in Figure 1 (modified from Krohn et al. and Krohn et al). Susceptibility to developing a thyroid nodule or goitre mainly in response to iodine deficiency is genetically determined. In genetically susceptible individuals with maladaptation to iodine deficiency, the increased thyroid epithelial cell proliferation and the increased production of H2O2 will lead to an increased rate of mutagenesis; depending on which gene is hit, this will lead to small clones of hot or cold thyroid cells, which will then give rise to hot or cold thyroid nodules or, less frequently, thyroid carcinomas. In areas not affected by nuclear fall-out, the annual incidence of thyroid cancer has been reported to range between 1.2 and 2.6 cases per 100,000 in men and 2.0 and 3.8 cases per 100,000 in women, with higher incidences in countries such as Sweden, France, Japan and the US. An increase of thyroid cancer incidence from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002 has recently been reported in the US. A similar increase of thyroid cancer incidence from 1983 to 2000 was reported in France, and the incidence of thyroid cancer in Germany in 2002 was 6.7 and 3.2 per 100,000 women and men, respectively. However, most of these increases in thyroid cancer incidence are due to an increased detection of small papillary cancers.
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Keywords:
Thyroid nodule, diagnosis, treatment, guidelines, evidence-based, thyroid nodules symptoms, thyroid nodule surgery, hyroid nodules hypothyroidism, hashimoto's thyroid nodules, benign thyroid nodule, thyryroid nodules ultrasound,
Thyroid nodule, diagnosis, treatment, guidelines, evidence-based, thyroid nodules symptoms, thyroid nodule surgery, hyroid nodules hypothyroidism, hashimoto's thyroid nodules, benign thyroid nodule, thyryroid nodules ultrasound,
