Guideline-orientated Diagnosis of Thyroid Nodules

Thyroid nodules are very common. Their aetiology is due to the interaction between genetic and environmental factors. In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME), the American Thyroid Association (ATA) and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scales make a rapid comparison of the strength of both evidence and recommendations difficult for use in current clinical practice. Some recommendations are based mostly on expert opinion. The same recommendation may be based on different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. A survey performed during an interactive symposium at the 32nd annual meeting of the ETA in Leipzig, Germany, was carried out to investigate whether these guidelines were able to affect the divergent management strategies for thyroid nodules that have previously been documented. The thyroid nodule guidelines obviously provide useful information and recommendations for practice and have a positive impact on patient care; however, guidelines should be considered as suggestions rather than a rigid formula for practice. With further accumulating evidence, these guidelines will need revision and updating.