Abstracts and short papers from the 5th Congress of the Polish Thyroid Association, Poznan, 3-5 September, 2015

A Committee of the American Thyroid Association (ATA) recently completed an up to date revision of Guidelines for the Management of Thyroid Nodules and Differentiated Thyroid Cancer [1]. The publication is voluminous with some 100 different recommendations, each of which is supported by summaries of the evidence available in the literature. This lecture could describe a few highlights of the many important recommendations. In each case, suggested management was indicated by both the strength of the recommendation (strong, weak, or none) and the quality of the evidence (low, moderate, high, or insufficient). For example, in a patient with a nodule about to undergo surgery, it is recommended that a pre-operative ultrasound of the neck be performed to delineate the contralateral lobe and the lymph nodes in the central and lateral neck compartments, and this was a ‘strong’ recommendation based on ‘moderate’ quality evidence. A significant departure from earlier guidelines is the recommendation that lobectomy rather than total thyroidectomy can suffice for nodules that are indeterminate on FNA (AUS/FLUS, follicular neoplasm) and also for nodules of <1 cm even with biopsy proven cancer. However, total thyroidectomy is still recommended for indeterminate nodules >4 cm, FNA positive thyroid cancers >1 cm, nodules for which the FNA shows marked atypia, or nodules in patients with a family history of thyroid cancer or a history of radiation exposure to the neck. A summarized and practical approach to management of nodules appears in our recent report [2]