Pathological practice and management of thyroid nodules: a Thai perspective

Although, in the thyroid field, there have been several internationally standard diagnostic and management guidelines for practitioners from every country to follow but there is still variation among physicians across the globe in taking care of patients and pathology specimens with thyroid nodules due to dissimilar backgrounds of each place. Thailand is one among several countries that tries to maintain standard of care to meet international requirements although, with some limitations, not all recommendations are followed. To understand how approaches of thyroid nodules are performed throughout the country and how the healthcare system of the whole kingdom is managed including what major current limitations, the authors conducted a survey among physicians consisting of surgeons, radiologists and pathologists who are involved in the management of the thyroid lesions by personal phone contact and custom online questionnaires. Performances of fine needle aspiration of different institutes are also evaluated by analyzing the data from available publications and compared their results with other series from the literature. Shortage of pathologists and un-equal resource allocation are the major problems concerning administrative aspect while a lack of awareness in new terminologies or diagnostic systems (e.g., NIFTP, UMP, Bethesda, TI-RADS) among physicians, particularly clinicians, are the problems of training and continuous medical education. Another point of concern is a rather poor performance in fine needle aspiration from the Thai series in which there are high rate (30.5%) of non-diagnostic category (Bethesda I) and false negativity as demonstrated by relatively high risk of malignancy (9.6%) in Bethesda II compared with other series from the literature. Regarding molecular studies, despite their usefulness in improving diagnostic accuracy, especially for cytology specimens, these ancillary tools are not routinely used in our practice since they are available in only few referral centers. This review provided a background information of the perspective on how thyroid nodules are managed in the Thai settings.