ATA Guidelines Tools

3 Thyroid Nodules Diagnosis 1. Screening people with familial follicular cell-derived differentiated thyroid cancer may lead to an earlier diagnosis of thyroid cancer, but the panel cannot recommend for or against ultrasound screening since there is no evidence that this would lead to reduced morbidity or mortality. (NR-I) 2. A) Serum TSH should be measured during the initial evaluation of a patient with a thyroid nodule. (SR-M) B) If the serum TSH is subnormal, a radionuclide (preferably 123 I) thyroid scan should be performed. (SR-M) C) If the serum TSH is normal or elevated, a radionuclide scan should NOT be performed as the initial imaging evaluation. (SR-M) 3. Routine measurement of serum Tg for initial evaluation of thyroid nodules is NOT recommended. (SR-M) 4. The panel cannot recommend either for or against routine measurement of serum calcitonin in patients with thyroid nodules. (NR-I) 5. A) Focal 18 FDG-PET uptake within a sonographically confirmed thyroid nodule conveys an increased risk of thyroid cancer, and fine needle aspiration is recommended for those nodules >1 cm. (SR-M) B) Diffuse 18 FDG-PET uptake, in conjunction with sonographic and clinical evidence of chronic lymphocytic thyroiditis, does not require further imaging or fine needle aspiration. (SR-M) 6. Thyroid sonography with survey of the cervical lymph nodes should be performed in all patients with known or suspected thyroid nodules. (SR-H) 7. FNA is the procedure of choice in the evaluation of thyroid nodules, when clinically indicated. (SR-H) 8. Thyroid nodule diagnostic FNA is recommended for (Figure 2, Table 1): A) Nodules >1cm in greatest dimension with high suspicion sonographic pattern. (SR-M) B) Nodules >1 cm in greatest dimension with intermediate suspicion sonographic. (SR-L) C) Nodules >1.5 cm in greatest dimension with low suspicion sonographic pattern. (WR-L) Thyroid nodule diagnostic FNA may be considered for (Figure 2, Table 1): D) Nodules >2 cm in greatest dimension with very low suspicion sonographic pattern (e.g., – spongiform). Observation without FNA is also a reasonable option. (WR-M) Thyroid nodule diagnostic FNA is not required for (Figure 2, Table 1): E) Nodules that do not meet the above criteria. (SR-M) F) Nodules that are purely cystic. (SR-M)

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