2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer
2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer
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DOI：
10.1089/thy.2015.0020
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发表时间：
2016-01-01
期刊：
影响因子：
6.6
通讯作者：
Wartofsky, Leonard
中科院分区：
文献类型：
--
作者：
Haugen, Bryan R.;Alexander, Erik K.;Wartofsky, Leonard
背景：甲状腺结节是临床常见的问题，分化型甲状腺癌的发病率也越来越高。自2009年美国甲状腺协会（ATA）对这些疾病的管理指南进行修订以来，该领域取得了重大科学进展。这些指南的目的是告知临床医生，患者，研究人员和卫生政策制定者有关甲状腺结节和分化型甲状腺癌诊断和管理的已发表证据。研究方法：这些指南中解决的具体临床问题是基于先前版本的指南、利益相关者的意见和工作组成员的意见。工作队小组成员接受了知识综合方法方面的教育，包括电子数据库搜索、审查和选择相关引文以及对选定研究进行批判性评价。已发表的关于成人的英语文章符合纳入条件。美国医师学会指南分级系统用于对证据进行严格评估，并对治疗干预的建议进行分级。我们开发了一个类似格式的系统来评估这些研究的质量和由此产生的建议。指南小组完全独立于ATA编辑。定期更新、管理并向ATA和工作组成员传达指南工作组成员的竞争利益。结果如下：修订后的甲状腺结节管理指南包括关于初步评估、细针穿刺活检的临床和超声标准、细针穿刺活检结果的解释、分子标记物的使用和良性甲状腺结节的管理的建议。关于甲状腺癌初始治疗的建议包括甲状腺癌筛查、分期和风险评估、手术治疗、放射性碘残留消融和治疗以及使用左旋甲状腺素的促甲状腺激素抑制治疗。与分化型甲状腺癌长期治疗相关的建议包括：使用影像学和血清甲状腺球蛋白监测复发性疾病、甲状腺激素治疗、复发性和转移性疾病的治疗、临床试验和靶向治疗的考虑以及未来研究的方向。结论：我们已经制定了基于证据的建议，为甲状腺结节和分化型甲状腺癌管理的临床决策提供信息。在我们看来，它们代表了对这些疾病患者的当代最佳护理。
Background: 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. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.