A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules. Issue 2 (29th April 2017)

• Record Type: Journal Article
• Authors: Negro, Roberto; Attanasio, Roberto; Grimaldi, Franco; Frasoldati, Andrea; Guglielmi, Rinaldo; Papini, Enrico
• Is Part Of: European thyroid journal. Volume 6:Issue 2(2017)
• Page Start: 75
• Page End: 81
• Publication Date: 2017-04-29
• Subjects: Thyroid nodule -- Fine-needle aspiration -- Ultrasound -- Cytology -- Guidelines; Thyroid gland -- Diseases -- Periodicals; Thyroid Diseases -- Periodicals; 612.44
• DOI: 10.1159/000453032
• Languages: English
• ISSNs: 2235-0640

Abstract

Abstract : Background: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy. Objectives: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations. Methods: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey. Results: A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively). Conclusions: Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.