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Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

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1 University of Colorado School of Medicine , Aurora, Colorado.
2 Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
3 The Mayo Clinic , Rochester, Minnesota.
4 Boston Medical Center , Boston, Massachusetts.
5 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
6 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
7 The University of Siena , Siena, Italy .
8 Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts.
9 University Health Network, University of Toronto , Toronto, Ontario, Canada .
10 Institute Gustave Roussy and University Paris Sud , Villejuif, France .
11 Oregon Health and Science University , Portland, Oregon.
12 University of Texas M.D. Anderson Cancer Center , Houston, Texas.
13 Duke University School of Medicine , Durham, North Carolina.
14 University of Cincinnati Medical Center , Cincinnati, Ohio.
15 Memorial Sloan Kettering Cancer Center , New York, New York.
16 MedStar Washington Hospital Center , Washington, DC.



Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.


The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.


The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research.


We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.

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