ACR Appropriateness Criteria® thyroid carcinoma

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Thyroid carcinoma is the most common endocrine malignancy in the U.S.
• It often presents as a localized palpable nodule.
• Surgery is the primary treatment for well-differentiated thyroid cancer (WDTC).

Purpose of the Study:

• To provide evidence-based guidelines for managing patients with thyroid carcinoma.
• To review and update the American College of Radiology Appropriateness Criteria for thyroid cancer.
• To offer guidance on imaging and treatment procedures based on current medical literature and expert consensus.

Main Methods:

• Review of relevant medical literature from peer-reviewed journals.
• Application of a modified Delphi consensus methodology.
• Multidisciplinary expert panel review of imaging and treatment procedures.

Main Results:

• Surgery is the mainstay for WDTC, with complete resection yielding good outcomes.
• Thyroxine supplementation post-surgery suppresses TSH to prevent disease progression.
• Radioactive iodine (RAI) therapy is frequently used for diagnosis and treatment.
• External beam radiation therapy (EBRT) use is case-by-case due to limited trial data.
• Chemotherapy has a minimal role; novel systemic agents are under investigation for metastatic, iodine-refractory disease.

Conclusions:

• Surgery and RAI are key components in WDTC management.
• TSH suppression is crucial post-operatively.
• EBRT and chemotherapy have limited roles, with ongoing research into novel systemic therapies for advanced cases.