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Is the management of thyroid nodules and differentiated thyroid cancer in accordance with recent consensus guidelines? – Results of a national survey
Author(s) -
Van den Bruel A.,
MorenoReyes R.,
Bex M.,
Daumerie C.,
Glinoer D.
Publication year - 2008
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2007.03092.x
Subject(s) - medicine , thyroid carcinoma , thyroid , thyroid cancer , nodule (geology) , thyroid nodules , thyroglobulin , euthyroid , thyroidectomy , lymph node , histopathology , dissection (medical) , pathology , general surgery , radiology , paleontology , biology
Summary Objective To assess approaches to patients with a potentially malignant thyroid nodule and patients with differentiated thyroid carcinoma and compare them with the European Consensus and Guidelines by the American Thyroid Association. Design A survey of the 388 active members of the Belgian Thyroid Club. Methods A questionnaire addressing the management of an index case and four clinical variations (including variations in the size of the tumour and histological type). The index case was a 40‐year‐old euthyroid woman with a 3‐cm solitary thyroid nodule. Fine‐needle aspiration (FNA) cytology showed cellular aspirates with numerous follicular cells and no colloid. Results The overall response rate was 41%. For the index case, respondents favoured a right lobectomy. Variations in size and histopathology of the nodule altered the management. In the case of a papillary thyroid carcinoma (PTC) of 3 cm in diameter, a total thyroidectomy and prophylactic central lymph node dissection was preferred. After a lobectomy showing a 3·5‐cm follicular thyroid carcinoma (FTC), completion surgery followed by radioiodine administration was the most frequent proposal. For the follow‐up of the index case with a low‐risk disease, determination of serum thyroglobulin (Tg) after recombinant human TSH (rhTSH) administration was considered by the majority of respondents. For the follow‐up of a clinical variation with residual disease, immediate planning of a new treatment was (mistakenly) not considered by a majority of respondents. Conclusions In most cases, respondents were in accordance with the guidelines, although there were some unexpected variations.