Highlights & Basics
- Thyroid cancer most commonly presents as an asymptomatic thyroid nodule detected by palpation or ultrasound in women in their 30s or 40s.
- The most important diagnostic test is fine-needle aspiration.
- Treatment of differentiated (papillary, follicular) thyroid cancer and Hürthle cell carcinoma depends on pretreatment assessment of risk and usually includes total thyroidectomy or lobectomy. Risk adjustment based on surgical and pathologic findings determines if radioactive iodine ablation, thyroid-stimulating hormone (TSH) suppression, or both is indicated.
- Treatment differs and must be tailored for uncommon types of thyroid cancer such as anaplastic, medullary, or primary thyroid lymphoma.
- Prognosis depends on risk-group stratification.
Quick Reference
History & Exam
Key Factors
palpable thyroid nodule
female sex
history of head and neck irradiation
Other Factors
extremes of age
family history of thyroid cancer
hoarseness
dyspnea
dysphagia
tracheal deviation
cervical lymphadenopathy
rapid neck enlargement
Diagnostics Tests
1st Tests to Order
TSH
ultrasound, neck
fine-needle aspiration
Other Tests to consider
molecular analysis of cytology specimens
free T4
free T3
laryngoscopy
I-123 thyroid scan and uptake
core biopsy
CT neck
serum calcitonin
genetic testing for familial syndromes
Emerging Tests
translaryngeal ultrasound
sentinel node biopsy
Treatment Options
ongoing
papillary, follicular, or Hürthle
newly diagnosed
recurrent or metastatic disease
anaplastic
surgery + chemoradiation
targeted therapy
Definition
Classifications
Types of thyroid cancer
- Hürthle cell carcinoma (HCC): accounts for 3% to 4% of thyroid cancers and used to be classified as a variant of follicular thyroid tumors, but is now a distinct separate entity.[3] Hürthle cells are oncocytic cells with a classic cytologic appearance of large cells with abundant eosinophilic, granular cytoplasms, and large hyperchromatic nuclei with prominent nucleoli. HCCs are Hürthle cell tumors with capsular and/or vascular invasion, lymph node metastasis, or distant metastasis and are considered to be more aggressive than non-oncocytic thyroid carcinomas.[3]
- Anaplastic: an undifferentiated neoplasm with mitosis and vascular invasion. It usually presents with local encroachment into the recurrent laryngeal nerve and trachea, muscle, and/or esophagus.[4]
- Medullary: originates in thyroid parafollicular C cells and accounts for about 1% to 3% of thyroid cancers.[5] It occurs in sporadic and familial forms. A minority (about one quarter) of cases are familial: for example, part of multiple endocrine neoplasia (MEN) syndromes. There is a tendency to multicentricity and early lymph node spread.Images
2022 World Health Organization classification: thyroid tumors
- Follicular nodular disease
- Follicular adenoma
- Follicular adenoma with papillary architecture
- Oncocytic adenoma
- Non-invasive follicular neoplasm with papillary-like nuclear features
- Tumors of uncertain malignant potential
- Follicular tumor of uncertain malignant potential
- Well-differentiated tumor of uncertain malignant potential
- Hyalinizing trabecular tumor
- Follicular carcinoma
- Invasive encapsulated follicular variant papillary carcinoma
- Papillary carcinoma
- Oncocytic carcinoma
- Follicular-derived carcinomas, high-grade
- Poorly differentiated carcinoma
- Differentiated high-grade carcinoma
- Anaplastic follicular cell-derived carcinoma
Bethesda system for reporting thyroid cytopathology
- Nondiagnostic or unsatisfactory
- Cyst fluid only
- Virtually acellular specimen
- Other (obscuring blood, clotting artifact, drying artifact, etc.)
- Benign
- Consistent with follicular nodular disease (includes adenomatoid nodule, colloid nodule, etc.)
- Consistent with chronic lymphocytic (Hashimoto) thyroiditis in the proper clinical context
- Consistent with granulomatous (subacute) thyroiditis
- Other
- Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance
- Specify if AUS-nuclear atypia or AUS-other
- Follicular neoplasm or suspicious for a follicular neoplasm
- Specify if oncocytic (formerly Hürthle cell) type
- Suspicious for malignancy
- Suspicious for papillary thyroid carcinoma
- Suspicious for medullary thyroid carcinoma
- Suspicious for metastatic carcinoma
- Suspicious for lymphoma
- Other
- Malignant
- Papillary thyroid carcinoma
- High-grade follicular-derived carcinoma
- Medullary thyroid carcinoma
- Undifferentiated (anaplastic) carcinoma
- Squamous cell carcinoma
- Carcinoma with mixed features (specify)
- Metastatic malignancy
- Non-Hodgkin lymphoma
- Other
TNM staging of thyroid cancer
- Size and extent of the primary tumor (T)
- Regional lymph node involvement (N)
- Presence or absence of distant metastases (M).
Vignette
Common Vignette
Other Presentations
Epidemiology
Etiology
- Follicular thyroid carcinomas are associated with RAS mutations or have a chromosomal translocation that fuses the paired box gene 8 with the PPAR (peroxisome proliferator-activated receptor) gamma gene, the PAX8-PPARG fusion oncogene.[1]
Pathophysiology
Images
Histopathology of papillary carcinoma, thyroid: a psammoma body is visible (arrow)
Histopathology of follicular carcinoma, thyroid
Hürthle cells with abundant granular, eosinophilic cytoplasm and 'cherry pink' nucleoli
Hürthle cell carcinoma: presence of tumor cells within a vein, indicative of vascular invasion
Medullary thyroid cancer: H&E stain showing nests of tumor cells
Medullary thyroid cancer: calcitonin stain
Skull x-ray showing extensive metastases from follicular thyroid carcinoma
Increased uptake of radioiodine in both pulmonary fields and the mediastinum due to miliary lung metastasis from papillary thyroid carcinoma
CT of neck pre- and post-operative: tracheal compression by a thyroid lymphoma
Diagnostic Approach
Examination and detection
Tests
Emerging investigations
- Translaryngeal ultrasound is an emerging modality to evaluate vocal cords preoperatively. If there is an abnormality seen on vocal cord ultrasonography, this can then be followed by fiberoptic laryngoscopy. Overall this is a noninvasive technique that can be performed with ease at the office visit.[55]
Risk Factors
History & Exam
Tests
Differential Diagnosis
Differentiating Signs/Symptoms
- These may lack hard consistency, fixation, or associated adenopathy. Vocal cord paralysis is generally absent. However, these findings are not diagnostic.
Differentiating Tests
- Fine-needle aspiration generally shows benign cytology with abundance of colloid.
- For follicular cell adenomas, permanent surgical pathology shows lack of vascular and capsular invasion.
Criteria
- Female sex
- Age <55 years
- Size of nodule <4 cm
- No extrathyroidal extension
- Absence of metastatic disease
- Low-grade histology.
- Low-risk: intrathyroidal differentiated thyroid cancer; ≤5 lymph node micrometastases (<0.2 cm)
- Intermediate-risk: aggressive histology, minor microscopic extrathyroidal extension, vascular invasion, or >5 involved lymph nodes (0.2 to 3.0 cm)
- High-risk: gross extrathyroidal extension, incomplete tumor resection, distant metastases, or lymph nodes >3.0 cm).
Screening
Treatment Approach
Differentiated thyroid cancer: papillary, follicular, or Hürthle cell
- In patients with high-risk disease, a serum TSH level of <0.1 mIU/L is recommended.[2] More significant TSH suppression (i.e., serum TSH <0.1 mIU/L but not necessarily undetectable) is recommended in patients with residual structural disease or a biochemically incomplete response if they are young or at low risk of complications such as exogenous subclinical hyperthyroidism.[77]
- For intermediate-risk thyroid cancer patients, initial TSH suppression to 0.1 to 0.5 mIU/L is recommended.[2]
- Remnant ablation - to destroy postoperatively residual, presumably benign thyroid tissue to facilitate initial staging and follow-up studies
- Adjuvant treatment - additional treatment given after the primary treatment to lower the risk of recurrence
- Treatment of known biochemical or structural disease.
- Biochemical recurrence or persistence without evidence of structural disease: may be managed with observation and surveillance with appropriate imaging studies performed at time intervals guided by the thyroglobulin doubling time.[88]
- Suspected structural neck recurrence: biopsy-proven persistent or recurrent disease may require additional therapies or may be managed with observation and serial cross-sectional imaging (e.g., contrast-enhanced computed tomography [CT] or magnetic resonance imaging [MRI]) at a frequency sufficient to identify clinically significant disease progression.[88] Recurrent structural disease that measures 8-10 mm or larger on anatomic imaging in the central and lateral neck, respectively, is considered for revision surgery.[2] [88]
Anaplastic thyroid cancer
- If possible a total thyroidectomy is done; however, determining whether a patient is a candidate for surgery depends on the tumor's resectability, extent of local invasion, need for urgent tracheostomy, presence of distant metastases, and the patient's performance status and treatment goals.[14]
- Regardless of the surgical status, external radiation should be considered early in the treatment of anaplastic thyroid cancer.[97]
- Cytotoxic chemotherapy with paclitaxel, docetaxel, or combined treatments (e.g. carboplatin/paclitaxel, docetaxel/doxorubicin) is associated with very low response rates and significant toxicities; however, it may be used for its radiosensitizing effect when combined with radiation therapy or considered by patients wishing aggressive treatment as a bridge to targeted therapy while awaiting results of molecular profiling.[14]
- Use of targeted therapy in patients with anaplastic thyroid cancers depends on the results of genetic testing:
- BRAF V600E mutation positive: combination therapy with the BRAF inhibitor dabrafenib plus the MEK inhibitor trametinib may be offered.[14] [73] When successful, BRAF-directed therapy has been shown to induce rapid and significant tumor regression, such that patients who were previously inoperable may be candidates for surgery.[98]
- Other targeted therapies (e,g,. selpercatinib or pralsetinib if RET fusion positive) and immunotherapy may be considered in the setting of a clinical trial, as the number of anaplastic thyroid cancer cases in existing trials have been limited, such that no robust conclusions can be made for the time being.[73] [97] [98]
Medullary thyroid cancer
Thyroid lymphoma
- Diffuse B-cell lymphomas have an aggressive clinical course and should be considered for multimodal treatment with the monoclonal antibody rituximab, chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]), and radiation therapy.[7]
- Mucosa-associated lymphoid tissue lymphomas pursue a more indolent course and may be treated adequately with surgery alone, radiation therapy alone, or a combination of both.[7]
Treatment Options
papillary, follicular, or Hürthle
newly diagnosed
radioactive iodine therapy
Comments
- Selecting an optimal dose (activity) of radioactive iodine for successful ablation is challenging in patients with differentiated thyroid carcinoma after thyroidectomy.[82] Radioactive iodine therapy is not routinely recommended in patients with low-risk differentiated thyroid cancer; however, in those who may benefit (e.g., elevated serum thyroglobulin or with abnormal ultrasound findings identified in post-surgical follow-up), use of a lower radioactive iodine dose appears equally efficacious.[83] [84] [85] [86] Use of, and dosing strategy in, radioactive iodine therapy for patients with intermediate-risk disease is highly individualized and is defined on a case-by-case basis.[83] High doses of radioactive iodine are preferred over low-dose radioactive iodine in patients with a high risk of recurrent disease.[80]
- Increased thyroid-stimulating hormone (TSH) levels are required to induce radioactive iodine uptake in thyroid cells.[80] Historically this was achieved by withdrawal of thyroid replacement therapy, which results in hypothyroidism and subsequent rise in TSH levels; however, hypothyroidism is associated with adverse patient outcomes.[2] Administration of exogenous recombinant human TSH (rhTSH) is now the preferred method of preparation for radioactive iodine therapy and is approved for use in any patient except those with distant metastases.[80]
- Following radioactive iodine therapy, a radioactive iodine whole-body scan is obtained to stage the disease and document the radioactive iodine avidity of any structural lesions.[72]
recurrent or metastatic disease
observation and surveillance ± surgery ± radioactive iodine therapy ± directed therapies (e.g., external beam radiation therapy, thermal ablation)
Comments
- The risk of recurrence is determined at time of diagnosis and re-evaluated as a continuum in response to early therapies.[64]
- Patients treated with total thyroidectomy and radioactive iodine are classified at each follow-up visit as having an excellent, biochemically incomplete, structurally incomplete, or indeterminate response to therapy.[2]
- Biochemical recurrence or persistence without evidence of structural disease: may be managed with observation and surveillance with appropriate imaging studies performed at time intervals guided by the thyroglobulin doubling time.[88]
- Suspected structural neck recurrence: biopsy-proven persistent or recurrent disease may require additional therapies or may be managed with observation and serial cross-sectional imaging (e.g., contrast-enhanced CT or MRI) at a frequency sufficient to identify clinically significant disease progression.[88] Recurrent structural disease that measures 8-10 mm or larger on anatomic imaging in the central and lateral neck, respectively, is considered for revision surgery.[2] [88]
- Metastatic disease is managed with a hierarchy of treatment modalities: TSH-suppressive thyroid hormone therapy alone (if stable or slowly progressive asymptomatic metastatic disease); surgical excision of locoregional disease; radioactive iodine therapy; directed local therapies (e.g., external beam radiation therapy, thermal ablation); and systemic therapy with kinase inhibitors.[2]
targeted therapy
Primary Options
Secondary Options
Comments
- Treatment with kinase inhibitors may be considered in patients with progressive differentiated thyroid cancer that is not responsive to conventional approaches and who have considerable tumor load.[33] Genetic testing targeting actionable cancer mutations is recommended prior to initiating therapy whenever possible to individualize therapy.[71] [73] [90]
- Cabozantinib is an MKI approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for treating adults with radioactive iodine-refractory differentiated thyroid cancer who progressed during previous treatment with sorafenib or lenvatinib.[73] [90][93] However, in the UK, the National Institute for Health and Care Excellence does not recommend cabozantinib within its marketing authorization (treating locally advanced or metastatic differentiated thyroid cancer unsuitable for or refractory to radioactive iodine that has progressed on prior systemic therapy) because of uncertainty regarding overall survival benefit.[94]
- Selpercatinib and pralsetinib are selective RET kinase inhibitors approved by the FDA for the treatment of adults with advanced or metastatic radioactive iodine-refractory differentiated thyroid cancer harboring an RET fusion gene.[90] [95] Selpercatinib improved progression-free survival compared with cabozantinib or vandetanib in one phase 3 trial of patients with RET-mutant medullary thyroid cancer.[96] Selpercatinib is approved by the EMA for adults with advanced RET fusion‑positive thyroid cancer who require systemic therapy following prior treatment with sorafenib and/or lenvatinib.[73]
- The optimal sequence of MKIs and selective kinase inhibitors in RAI-refractory, advanced, or metastatic differentiated thyroid cancers cannot be determined from currently available evidence and varies internationally based on regulatory constraints.[73] Factors that determine decision-making include the expected treatment response, the drug safety profile, and the patient's preference.[73]
- See local specialist protocol for dosing guidelines.
anaplastic
surgery + chemoradiation
Primary Options
Comments
- Tumors in patients with anaplastic thyroid cancer usually present at an advanced stage, display extremely aggressive behavior, and are associated with a very poor prognosis.[73] Distant metastatic disease is highly probable either at or soon after diagnosis.[97] Early multidisciplinary involvement including the palliative care teams is important to support patient decision-making.[14] Determining the extent of disease and assessing for mutations influences the treatment options and goals of care.[97]
- Combining multiple therapeutic modalities is the most effective approach to anaplastic thyroid cancer and needs to be individualized to optimally balance treatment utility while limiting comorbidities: surgery + radiation; or surgery + systemic therapy; or surgery + radiation + systemic therapy.[67] [97]
- If possible a total thyroidectomy is done; however, determining whether a patient is a candidate for surgery depends on the tumor's resectability, extent of local invasion, need for urgent tracheostomy, presence of distant metastases, and the patient's performance status and treatment goals.[14] Thyroid hormone replacement is required if total thyroidectomy is done.
- Regardless of the surgical status, external radiation should be considered early in the treatment of anaplastic thyroid cancer.[97]
- Cytotoxic chemotherapy with paclitaxel, docetaxel, or combined treatments (e.g., carboplatin/paclitaxel, docetaxel/doxorubicin) is associated with very low response rates and significant toxicities; however, it may be used for its radiosensitizing effect when combined with radiation therapy or considered by patients wishing aggressive treatment as a bridge to targeted therapy while awaiting results of molecular profiling.[14]
- See local specialist protocol for chemotherapy dosing guidelines.
targeted therapy
Primary Options
Comments
- Use of targeted therapy in patients with anaplastic thyroid cancers depends on the results of genetic testing.
- If BRAF V600E mutation positive, combination therapy with the BRAF inhibitor dabrafenib plus the MEK inhibitor trametinib may be offered.[14] [73] When successful, BRAF-directed therapy has been shown to induce rapid and significant tumor regression, such that patients who were previously inoperable may be candidates for surgery.[98]
- Other targeted therapies (e,g,. selpercatinib or pralsetinib if RET fusion positive) and immunotherapy may be considered in the setting of a clinical trial, as the numbers of anaplastic thyroid cancer cases in existing trials have been limited, such that no robust conclusions can be made for the time being.[73] [97] [98]
- See local specialist protocol for dosing guidelines.
medullary
newly diagnosed
thyroid hormone replacement
Primary Options
- levothyroxine
consult specialist for guidance on dose
- levothyroxine
Comments
- Replacement rather than suppression is required, because medullary cancer is not sensitive to thyroid-stimulating hormone (TSH).
recurrent or metastatic disease
surgery ± external radiation therapy ± focal treatments
Comments
- Recurrences are treated with additional surgery, plus external radiation therapy if local control cannot be achieved.[99]
- In metastatic disease, surgery may be indicated for patients in which a single or a few metastases are located in the brain, lungs, or liver.[99] Focal treatments including external radiation therapy, stereotaxic radiosurgery, radiofrequency ablation, or chemoembolization are used depending on the site of metastases.[5] [99]
targeted therapy
Primary Options
Secondary Options
Comments
- Targeted therapy against the kinases of VEGFR2 and RET have produced high response rates in patients with metastatic medullary thyroid cancer.[99] US and European guidelines recommend the multikinase inhibitors, cabozantinib and vandetanib, as first-line systemic therapy for patients with progressive, metastatic medullary thyroid cancer regardless of RET mutational status.[71] [73] The selected RET inhibitors selpercatinib and pralsetinib are approved for use in the treatment of advanced or metastatic medullary thyroid cancer harboring an RET mutation.[71] [73]
- See local specialist protocol for dosing guidelines.
thyroid hormone replacement
Primary Options
- levothyroxine
consult specialist for guidance on dose
- levothyroxine
Comments
- Replacement rather than suppression is required, because medullary cancer is not TSH-sensitive.
primary thyroid lymphoma
chemotherapy + external radiation
Primary Options
Comments
- Management of primary thyroid lymphoma depends on the disease subtype and stage.[6]
- Diffuse B-cell lymphomas have an aggressive clinical course and should be considered for multimodal treatment with the monoclonal antibody rituximab, chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]), and radiation therapy.[7]
- Mucosa-associated lymphoid tissue lymphomas pursue a more indolent course and may be treated adequately with surgery alone, radiation therapy alone, or a combination of both.[7] The most common treatment regimen is CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy plus radiation.
- See local specialist protocol for dosing guidelines.
Emerging Tx
Molecular and immune targets
Redifferentiation therapy
Prevention
Primary Prevention
Secondary Prevention
Follow-Up Overview
Prognosis
- The most common type, papillary carcinoma, is indolent, with an average 10-year survival >90%.[2] Recurrence and risk of metastasis are low after surgery. Surgical complications are few when surgery is done by experts. Nodal metastases in papillary carcinoma increase the risk of recurrence but do not affect overall survival. If a patient has undergone positron emission tomography (PET) scanning, a positive scan is an indicator of worse prognosis than a negative result. Most patients who undergo PET scanning are older patients who have poorly differentiated tumors.
- Follicular carcinoma has a slightly worse prognosis than papillary and tends to have systemic metastasis. The survival rate for localized follicular cancer is almost 100% and for distant follicular cancer is 63%.[103]
- Overall 5-year survival for localized medullary cancer is almost 100% and for distant medullary cancer is 75%.[103]
- For primary thyroid lymphoma, the 5-year survival is 66%.[6]
- Anaplastic thyroid carcinoma is aggressive, with a historic average survival of a few months. Molecular testing at patient presentation became standard of care in the 2014-2019 era, and the use of targeted therapy is associated with improved median overall survival of 1.31 years in those receiving targeted therapy versus 0.63 years in those who did not.[104]
Monitoring
- For patients treated with total thyroidectomy and adjuvant radioactive iodine (RAI) therapy, a whole-body RAI scan at 6 to 12 months after adjuvant RAI therapy is suggested for patients at high or intermediate risk of persistent disease.[2] Recombinant human thyroid-stimulating hormone (TSH) is used to increase the TSH levels, while the patient continues to be on thyroid hormone replacement. The scan detects residual thyroid tissue in the neck and also metastases.Image
- During follow-up the best investigations are thyroglobulin, thyroglobulin antibody, and clinical exam. Thyroglobulin panel is an important investigation if the patient has undergone total thyroidectomy and radioiodine ablation. Any rise in thyroglobulin or thyroglobulin antibody is suggestive of recurrent thyroid carcinoma, most of which is recurrence in either the central compartment of the neck or the lateral neck.[29]
- Although there is no definitive cutoff for thyroglobulin, >2 nanograms/mL is considered worrisome and >10 nanograms/mL suggests recurrent thyroid carcinoma. Thyroglobulin panel (including antibodies) may be performed twice yearly for the first 5 years and subsequently once yearly (if normal).
- Ultrasound is done at baseline, and then annually combined with more frequent clinical examinations. Ultrasound may detect recurrent disease in the thyroid bed, the paratracheal area, or the lateral neck.
- An elevated thyroglobulin or rising thyroglobulin antibodies are generally investigated with ultrasound and whole-body RAI scan. Recurrent disease or metastasis is ablated with I-131. Surgery may also be used for accessible disease.
- Positron emission tomography/computed tomography (PET/CT) can be used to look for recurrent disease in patients with raised thyroglobulin and negative radioactive iodine scan.[110]
- Medullary cancer is monitored with serum calcitonin every 3 months for 2 years, followed by every 6 months for 3 years. If levels are undetectable they can then be followed annually. If serum calcitonin is elevated, ultrasound and CT of the neck/chest are indicated. If both are negative, PET scan may detect lesions missed by CT.[110]
- Incidence of permanent hypocalcemia due to parathyroid injury is extremely low. If postoperative hypocalcemia persists for >3 weeks, it is more likely to be permanent. Treatment is with oral calcium and vitamin D.
Complications
Citations
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Key Articles
Other Online Resources
Referenced Articles
Guidelines
Diagnostic
Summary
This guideline provides a comprehensive overview of the management of this cancer.Published by
National Comprehensive Cancer Network
Published
2023
Summary
Intended to assist practitioners performing sonographic evaluation of the extracranial head and neck, including evaluation of the thyroid gland.Published by
American College of Radiology, American Institute of Ultrasound in Medicine, Society for Pediatric Radiology, Society of Radiologists in Ultrasound
Published
2022
Summary
Evidence-based recommendations for the radiologic investigation of thyroid disease.Published by
American College of Radiology
Published
2018
Summary
Advises considerations for thyroid ultrasound before fine-needle aspiration.Published by
American Thyroid Association
Published
2016
Summary
Evidence-based recommendations to inform clinical decision-making in the management of anaplastic thyroid cancer.Published by
American Thyroid Association
Published
2021
Summary
Evidence-based recommendations to assist clinicians in the care of patients with medullary thyroid carcinoma.Published by
American Thyroid Association
Published
2015
Summary
Recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and differentiated thyroid cancer in children and adolescents.Published by
American Thyroid Association
Published
2015
Summary
A multidisciplinary evidence-based statement on the definition of advanced thyroid cancer and its targeted systemic treatment.Published by
American Head and Neck Society Endocrine Surgery Section; International Thyroid Oncology Group
Published
2022
Summary
Recommendations from an intersocietal working group on diagnosis, risk stratification, and scanning.Published by
American Thyroid Association, European Association of Nuclear Medicine, European Thyroid Association, Society of Nuclear Medicine and Molecular Imaging
Published
2021
Summary
Outlines an approach to diagnosis of single and multiple thyroid nodules.Includes a description of fine-needle aspiration and other diagnostic tools.Published by
American Association of Clinical Endocrinologists; American College of Endocrinology; Associazione Medici Endocrinologi
Published
2016
Summary
Diagnostic recommendations for thyroid cancer including thyroid ultrasound, fine-needle aspiration cytology, and immunohistochemical markers.Published by
European Society for Medical Oncology
Published
2019
Treatment
Summary
This guideline provides a comprehensive overview of the management of this cancer.Published by
National Comprehensive Cancer Network
Published
2023
Summary
Guidelines for management of patients with anaplastic thyroid cancer.Published by
American Thyroid Association
Published
2021
Summary
Guidance for appropriately trained and licensed physicians treating thyroid disease with I-131 sodium iodide.Published by
American College of Radiology, American College of Nuclear Medicine, American Society for Radiation Oncology, Society of Nuclear Medicine and Molecular Imaging, Society for Pediatric Radiology
Published
2019
Summary
Outlines management of differentiated thyroid cancers.Published by
American Thyroid Association
Published
2016
Summary
Evidence- and expert opinion-based recommendations for the management of thyroid nodules and differentiated thyroid cancer in children and adolescents.Published by
American Thyroid Association
Published
2015
Summary
Outlines management of medullary thyroid cancer.Published by
American Thyroid Association
Published
2015
Summary
Treatment and follow-up recommendations for differentiated thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.Published by
European Society for Medical Oncology
Published
2019