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Neoplasm of thyroid gland — Clinical Guidelines

Overview

Thyroid neoplasms encompass a spectrum of conditions ranging from benign to malignant tumors, with the majority being benign. Surgical intervention, including total or partial thyroidectomy, is commonly required for definitive management 2.

Diagnosis

Fine-needle aspiration cytology (FNAC): Essential for preoperative risk stratification.

- Thy1: Low risk of malignancy (ROM) 12% 3. - Thy2: Lower risk, ROM 5% 3. - Thy3: Higher risk, ROM 22% 3. - Thy3a: Elevated risk, ROM 25% 3.

Histological evaluation: Crucial for definitive diagnosis post-surgery.

Nuclear scoring criteria: Important for diagnosing noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) 4.

Immunohistochemistry: Useful in distinguishing rare variants like meningioma-like tumors and Schwannomas 5 9.

Vitamin D assessment: Consider evaluating vitamin D status preoperatively, as it may have implications for patient health 2.

Management

Surgical excision: Total or subtotal thyroidectomy based on lesion characteristics and extent 2.

Frozen section analysis: Limited utility in definitive diagnosis of follicular neoplasms or Hürthle cell neoplasms; more useful for suspicious cases 6.

Post-surgical surveillance: Regular follow-up necessary, especially for indeterminate or borderline lesions 7.

Specific treatments: Not detailed in abstracts; individualized based on pathology results.

Special Populations

Pregnancy: No specific guidelines provided in abstracts.

Pediatrics: No specific guidelines provided in abstracts.

Elderly: Consider comorbidities and surgical risks; individualized management recommended 7.

Comorbidities: Management should account for coexisting conditions, particularly those affecting surgical risk 7.

Key Recommendations

Utilize fine-needle aspiration cytology (FNAC) for preoperative risk stratification of thyroid nodules 3. (Evidence: Strong)

Perform surgical excision (total or subtotal thyroidectomy) based on lesion characteristics 2. (Evidence: Expert opinion)

Limit intraoperative frozen section use to suspicious cases where definitive guidance is critical 6. (Evidence: Moderate)

Consider preoperative vitamin D status assessment to inform overall patient health 2. (Evidence: Moderate)

Individualize management in elderly patients and those with comorbidities, focusing on comprehensive risk assessment 7. (Evidence: Expert opinion)

References

1 Jiao J, Yang F, Zhang Y, Shang FJ, Wu BQ. Primary thyroid smooth muscle tumour. Endokrynologia Polska 2023. link 2 Maciejewska-Markiewicz D, Kochman J, Jakubczyk K, Bargiel P, Szlosser Z, Stachowska E et al.. Vitamin D Status in Patients before Thyroidectomy. International journal of molecular sciences 2023. link 3 Poller DN, Bongiovanni M, Trimboli P. Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta-analysis. Cancer cytopathology 2020. link 4 Thompson LDR, Poller DN, Kakudo K, Burchette R, Nikiforov YE, Seethala RR. An International Interobserver Variability Reporting of the Nuclear Scoring Criteria to Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: a Validation Study. Endocrine pathology 2018. link 5 Tanvir I, Riaz S, Khan HA, Shehzadi I. Meningioma like tumour of thyroid: a rare variant of follicular adenoma. JPMA. The Journal of the Pakistan Medical Association 2014. link 6 LiVolsi VA, Baloch ZW. Use and abuse of frozen section in the diagnosis of follicular thyroid lesions. Endocrine pathology 2005. link 7 Perrier ND, Ituarte PH, Treseler P, D'Avanzo A, Siperstein A, Duh QY et al.. Classification and treatment of follicular thyroid neoplasms are discordant between and within medical specialties. Surgery 1999. link 8 Richardson H, Hill J, Bennett M, Mathias DB. Massive thyroid oncocytoma. The Journal of laryngology and otology 1991. link 9 Ruchti C, Gerber HA, Schaffner T. Factor VIII-related antigen in malignant hemangioendothelioma of the thyroid: additional evidence for the endothelial origin of this tumor. American journal of clinical pathology 1984. link 10 Goldstein J, Tovi F, Sidi J. Primary Schwannoma of the thyroid gland. International surgery 1982. link

Neoplasm of thyroid gland