Thyroid Nodules and Differentiated Thyroid Cancer -- Differentiated Cancer

Document Overview

Document Title

Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Authoring Society

American Thyroid Association

Document Publication Date

Jan 12, 2016

Page Last Reviewed/Updated

Feb 5, 2026

Document Type

Guideline

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

www.liebertpub.com/doi/full/10.1089/thy.2015.0020

Supplemental Implementation Resources

• Quick-Reference Guide
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• Podcast
• Patient Information
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Document Scope, Criteria, and Use Cases

Document Objectives

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.

Scope

Assessment and Screening, Counseling, Diagnosis, Management, Prevention, Treatment

Keywords

DTC, Thyroid Cancer, differentiated thyroid cancer (DTC), thyroid nodules

Target Patient Population

Adult patients with thyroid nodules and Differentiated thyroid cancer

Health Care Settings

Ambulatory, Hospital, Operating and Recovery Room, Outpatient, Radiology Services

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

1. What is the appropriate operation for cytologically indeterminate thyroid nodules?
2. What is the role of systemic therapy (kinase inhibitors, other selective therapies, conventional chemotherapy, bisphosphonates, denosumab) in treating metastatic determinate thyroid nodules?
3. What is the role of radioiodine therapy after thyroidectomy in the primary management of determinate thyroid nodules?
4. What is the role of thyroid cancer screening in people with familial follicular cell–derived DTC?
5. What is the appropriate laboratory and imaging evaluation for patients with clinically or incidentally discovered thyroid nodules?
6. What is the role of FNA, cytology interpretation, and molecular testing in patients with thyroid nodules?
7. What are the principles of the molecular testing of FNA samples?
8. What is the utility of 18FDG -PET scanning to predict malignant or benign disease when FNA cytology is indeterminate (AUS/FLUS, FN, SUSP)?
9. What is the appropriate operation for cytologically indeterminate thyroid nodules?
10. How should multinodular thyroid glands (i.e., two or more clinically relevant nodules) be evaluated for malignancy?
11. What are the best methods for long-term follow-up of patients with thyroid nodules?
12. What is the role of medical or surgical therapy for benign thyroid nodules?
13. How should thyroid nodules in pregnant women be managed?
14. What is the role of preoperative staging with diagnostic imaging and laboratory tests?
15. What is the appropriate perioperative approach to voice and parathyroid issues?
16. What are the basic principles of histopathologic evaluation of thyroidectomy samples?
17. What is the role of postoperative staging systems and risk stratification in the management of DTC?
18. What initial stratification system should be used to estimate the risk of persistent/recurrent disease?
19. How should initial risk estimates be modified over time?
20. Should postoperative disease status be considered in decision-making for RAI therapy for patients with DTC?
21. What is the role of RAI (including remnant ablation, adjuvant therapy, or therapy persistent disease) after thyroidectomy in the primary management of differentiated thyroid cancer?
22. How long does thyroid hormone need to be withdrawn in preparation for RAI remnant ablation/treatment or diagnostic scanning?
23. Can rhTSH (Thyrogen) be used as an alternative to thyroxine withdrawal for remnant ablation or adjuvant therapy in patients who have undergone near-total or total thyroidectomy?
24. What activity of 131I should be used for remnant ablation or adjuvant therapy?
25. Is a low-iodine diet necessary before remnant ablation?
26. Should a posttherapy scan be performed following remnant ablation or adjuvant therapy?
27. What is the appropriate degree of initial TSH suppression?
28. Is there a role for adjunctive external beam radiation or chemotherapy?
29. What are the appropriate features of long-term management?
30. What are the criteria for absence of persistent tumor (excellent response)?
31. What are the appropriate methods for following patients after initial therapy?
32. What is the role of serum Tg measurement in the follow-up of DTC?
33. What is the role of serum Tg measurement in patients who have not undergone RAI remnant ablation?
34. What is the role of US and other imaging techniques (RAI SPECT/CT, CT, MRI, PET-CT) during follow-up?
35. What is the role of TSH suppression during thyroid hormone therapy in the long-term follow-up of DTC?
36. What is the most appropriate management of DTC patients with metastatic disease?
37. What is the optimal directed approach to patients with suspected structural neck recurrence?
38. What is the surgical management of aerodigestive invasion?
39. How should RAI therapy be considered for loco-regional or distant metastatic disease?
40. How should distant metastatic disease to various organs be treated?
41. When should empiric RAI therapy be considered for Tg-positive, RAI diagnostic scan–negative patients?
42. What is the management of complications of RAI therapy?
43. How should patients who have received RAI therapy be monitored for risk of secondary malignancies?
44. What other testing should patients receiving RAI therapy undergo?
45. How should patients be counseled about RAI therapy and pregnancy, breastfeeding, and gonadal function?
46. How is RAI-refractory DTC classified?
47. Which patients with metastatic thyroid cancer can be followed without additional therapy?
48. What is the role for directed therapy in advanced thyroid cancer?
49. What is the role of systemic therapy (kinase inhibitors, other selective therapies, conventional chemotherapy, bisphosphonates) in treating metastatic DTC?

Number of Source Documents

1,078

Includes peer/external review process?

Yes

Includes public comment process?

Yes

Methodologist involvement?

No

Patient involvement?

No

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

Yes

Grades quality of strength of recommendation?

Yes

Discloses funding source?

Yes

Discloses conflicts of interest?

Yes

Includes benefits/harms analysis with recommendations?

Yes

Identifies study selection process?

Yes

Identifies study selection criteria?

Yes

Identifies methods used to evaluate and analyze the evidence?

Yes

Identifies key questions addressed by the systematic review?

Yes

Identifies search strategy?

Yes