Executive Summary of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults

Kepal N. Patel, MD; Linwah Yip, MD; Carrie C. Lubitz, MD, MPH; Elizabeth G. Grubbs, MD; Barbra S. Miller, MD; Wen Shen, MD; Peter Angelos, MD; Herbert Chen, MD; Gerard M. Doherty, MD; Thomas J. Fahey III, MD; Electron Kebebew, MD; Virginia A. Livolsi, MD; Nancy D. Perrier, MD; Jennifer A. Sipos, MD; Julie A. Sosa, MD; David Steward, MD; Ralph P. Tufano, MD; Christopher R. McHenry, MD; Sally E. Carty, MD


Annals of Surgery. 2020;271(3):399-410. 

In This Article

Abstract and Introduction


Objective: The aim of this study was to develop evidence-based recommendations for safe, effective and appropriate thyroidectomy.

Background: Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the United States.

Methods: The medical literature from January 1, 1985 to November 9, 2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content.

Results: These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches Laryngology Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation.

Conclusion: Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.


Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. To help provide safe, effective, and appropriate care of patients, these AAES-sponsored multidisciplinary clinical guidelines analyze the conduct, indications, and outcomes of adult thyroid surgery guided by a comprehensive evidence-based review of the medical literature. Several specific cautions to implementation exist. These guidelines were endorsed by the American Thyroid Association, the International Association of Endocrine Surgeons, the Society of Surgical Oncology, and the Graves' Disease and Thyroid Foundation.