Current Guidelines for the Management of Thyroid Nodules

Robert A. Levine, MD, FACE, ECNU


Endocr Pract. 2012;18(4):596-599. 

In This Article

Abstract and Introduction


Three sets of guidelines regarding management of thyroid nodules have been published during the past 3 years. The first set was issued by the American Thyroid Association (ATA),[1] the second was by the American Association of Clinical Endocrinologists (AACE), in collaboration with the Associazione Medici Endocrinologi (AME) and the European Thyroid Association (ETA),[2] and the most recent was by the Korean Society of Thyroid Radiology (KSTR).[3] These guidelines have many similarities, but each set takes a slightly different approach to recommending which nodules should undergo biopsy.

Thyroid nodules are extremely common. An estimated 4% of the population have a palpable thyroid nodule, and more than 50% have a nodule detectable by ultrasonography. With the frequent use of computed tomographic scans and carotid ultrasound studies, many thyroid nodules are found in asymptomatic patients. In my practice, this has generated more than one-third of referrals for consultation regarding a thyroid nodule. Each of the guidelines addresses which nodules necessitate a biopsy and which can be safely monitored or ignored.

All of these guidelines are part of comprehensive articles, with numerous references and detailed discussions of the rationale behind the recommendations. Collectively, they encompass 105 pages, with more than 700 references. This brief commentary can provide only the highlights of the recommendations, and readers are encouraged to refer to the original articles for the background information, the details regarding the recommendations, and the strength of evidence supporting the recommendations.