Complexity in the interpretation and application of multiple guidelines for thyroid nodules: the need for coordinated...

Multiple guidelines for thyroid nodule management have been developed by endocrinologists, often in collaboration with surgeons and radiologists. While there is now a lot of scientific information available to meet the needs of healthcare providers, there is not always uniformity and standardization among recommendations. Consequently, the interpretation and application of guidelines in clinical practice remain somewhat limited. In this context, the management of "small" thyroid nodule warrants full discussion. Looking at treatment guidelines, surgery is the first-line option and the risk of cancer relapse can be assessed only after at least thyroidectomy; in addition, according to guidelines of minimally invasive treatment, thermal ablation may be considered for patients with small classical papillary carcinoma. However, the Thyroid Imaging Reporting And Data Systems do not recommend biopsy in nodules less than 1 cm; and performing biopsy may yield a result that is suspicious or consistent with malignancy without specifying the cancer subtype. With these premises, facing cases of "small" nodule less than 1 cm is challenging. Even if the recommendations of guidelines sound singularly appropriate, they may seem conflicting. Coordinated guidelines are needed.