Endocrine Abstracts

Aim: Diagnostic definition and therapeutic interventions for nodular thyroid disease represent a high healthcare cost and their consequences may have a negative impact on quality of life of patients. This guideline aims at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. The purpose is to standardize the treatment, based on the evidence provided by the GRADE method and the expertise of a multidisciplinary expert panel.

Methods: Recommendations has been issued following the Methodological Manual for clinical practice guidelines developed by the Italian Istituto Superiore di Sanità, using the PICO approach (Population, Intervention, Comparison, Outcome). Efficacy of hemithyroidectomy with isthmectomy has been compared to total thyroidectomy, minimally invasive therapies, medical treatment, and no treatment. Based on the indications appointed by a multi-disciplinary panel, critical clinical outcomes were considered in the systematic review and formulation of recommendations.

Results: In patient with a benign non-hyperfunctioning thyroid nodule causing local symptoms, the therapeutic option must be proposed considering the clinical picture, the available resources and the preferences expressed by the patient. The recommended primary surgical treatment is hemithyroidectomy combined with isthmectomy, as long as no significant disease is detected in the opposite thyroid lobe. For patients with clinically significant disease in the opposite lobe, total thyroidectomy should be considered. Thermal ablation may be considered as an alternative to surgery in patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. TSH-suppressive treatment with L-thyroxine or radioiodine treatment are not indicated as a routine treatment option. Percutaneous ethanol injection should be considered as the preferential therapeutic option in a patient with a single or dominant benign thyroid nodule with a cystic or predominantly cystic structure causing local symptoms.

Conclusion: The recommendations contained in this guideline will be revised within three years from the date of publication. A new systematic literature review will verify the availability of new evidence that may influence the strength of recommendations. According to the data at hand, adopting guideline recommendations would likely lead to a gradual decrease in the number of surgical procedures for benign thyroid nodular disease. This could result in fewer admissions to surgical departments for non-cancerous cases and expedited treatment for patients with thyroid cancer. Additionally, a decrease in indirect costs related to extended replacement therapy and handling of surgical complications may be expected.