American Thyroid Association Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/631761
11 26. Individual patients with benign, solid or mostly solid nodules should have adequate iodine intake. If inadequate dietary intake is found or suspected, a daily supplement (containing 150 mcg iodine) is recommended. (SR-M) 27. A) Surgery may be considered for growing nodules that are benign after repeat FNA if they are large (>4 cm), causing compressive or structural symptoms, or based upon clinical concern. (WR-L) B) Patients with growing nodules that are benign after FNA should be regularly monitored. Most asymptomatic nodules demonstrating modest growth should be followed without intervention. (SR-L) 28. Recurrent cystic thyroid nodules with benign cytology should be considered for surgical removal or percutaneous ethanol injection (PEI) based on compressive symptoms and cosmetic concerns. Asymptomatic cystic nodules may be followed conservatively. (WR-L) 29. There are no data to guide recommendations on the use of thyroid hormone therapy in patients with growing nodules that are benign on cytology. (NR-I) 30. A) FNA of clinically relevant thyroid nodules should be performed in euthyroid and hypothyroid pregnant women. (SR-M) B) For women with suppressed serum TSH levels that persist beyond 16 weeks gestation, FNA may be deferred until after pregnancy and cessation of lactation. At that time, a radionuclide scan can be performed to evaluate nodule function if the serum TSH remains suppressed. (SR-M) 31. A) PTC discovered by cytology in early pregnancy should be monitored sonographically. If it grows substantially before 24–26 weeks gestation, or if US reveals cervical lymph nodes that are suspicious for metastatic disease, surgery should be considered during pregnancy. However, if the disease remains stable by midgestation, or if it is diagnosed in the second half of pregnancy, surgery may be deferred until after delivery. (WR-L). B) In pregnant women with FNA that is suspicious for or diagnostic of PTC, thyroid hormone therapy to keep the serum TSH 0.1–1.0mU/L is recommended. (WR-L).