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

Recommendations

1. Measure TSH for every thyroid nodule >1 cm (R2).

• Low TSH → do a radionuclide scan.
• Normal/high TSH → skip the scan.

2. Do not check serum thyroglobulin for initial work-up (R3).

• It’s nonspecific and not helpful diagnostically.

3. Calcitonin screening: no recommendation for or against (R4).

• Too much uncertainty; only consider it in special situations where the result might change management.

4. PET findings matter:

• Focal FDG uptake in a nodule ≥1 cm → do an ultrasound and FNA (R5A).
• Diffuse uptake + sonographic thyroiditis → no FNA needed (R5B).

5. Neck ultrasound for all patients with known or suspected nodules (R6).

• Include cervical lymph node survey.

6. FNA is the preferred diagnostic method (R7).

• Use ultrasound guidance when the nodule is cystic, poorly palpable, or posterior.

7. FNA criteria depend on ultrasound risk pattern (R8).

• High-suspicion nodules (solid, hypoechoic, microcalcifications, irregular margins, taller-than-wide): biopsy starting at 1 cm.
• Intermediate-suspicion: biopsy at ≥1 cm.
• Low-suspicion: biopsy at ≥1.5 cm.