Definitive Surgical Management of Thyroid Disease in Adults

1. Evaluation of thyroid disease should include specific inquiry about personal history, family history, clinical characteristics, and symptoms. (, )

2. The preoperative physical examination should include voice assessment. (, )

3. TSH should be measured in patients with nodular thyroid disease. Additional laboratory studies may help in specific circumstances. (, )

4. A diagnostic US should be performed in all patients with a suspected thyroid nodule. (, )

5a. US assessment of bilateral central and lateral lymph node ( LN) compartments should be performed in the preoperative evaluation of patients with cytologic evidence of thyroid carcinoma. (, )

5b. US assessment of bilateral central and lateral LN compartments may be performed in the preoperative evaluation of patients with indeterminate cytologic evidence of thyroid carcinoma. (Strong  “We recommend”, Insufficient)

6. CT or MRI with intravenous contrast should be used preoperatively as an adjunct to US in selected patients with clinical suspicion for advanced locoregional thyroid cancer. (Strong  “We recommend”, Low)