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Thyroid Nodule Guidelines

Clark, Orlo H. MD, FACS

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doi: 10.1097/SLA.0000000000003619
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I congratulate the AAES and their experts on developing guidelines for the management of patients with thyroid nodules, hyperthyroidism, and thyroid cancer. Although numerous guidelines have been previously published, the new guidelines here, which are modeled after the AAES guidelines for hyperparathyroidism, include preoperative localization studies, cytology, and molecular markers to help in the management of indeterminate thyroid nodules. These AAES sponsored multidisciplinary clinical guidelines are developed to help provide safe, effective, and appropriate care of patients.

The authors carefully review pertinent scientific literature regarding thyroid tumors of follicular and parafollicular origin, including patients with recurrent or persistent disease. New treatments such as active surveillance for older patients with small papillary thyroid cancers have been recommended. The authors also report higher complication rates in patients with Graves’ disease and in those requiring re-operations. The authors comment on the value of preoperative scanning and the techniques used for such scans. The risks and benefits of central neck lymph node dissection for patients with tumors of follicular and C-cell origin are presented. Thyroglobulin and calcitonin doubling times are helpful in predicting tumor aggressiveness.

Other information includes the use of dexamethasone (8 mg) preoperatively to decrease nausea and vomiting. The authors note that no benefits occur with the use of antibiotics, skin creams, or drains. For patients whose localizing studies indicate a tumor on 1 side, the authors recommend removing the involved lobe first. Repair of the recurrent laryngeal nerve improves voice quality, as does treatment with Nimodipine.

These new guidelines provide a wealth of information to help guide the surgeon in the management of thyroid nodules and thyroid cancers. Surgeons should benefit from reading them.

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