European perspective on the 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Proceedings of an interactive international symposium.

Available online from MWHC library: August 2000 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: The American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer (DTC) are highly influential practice recommendations. The latest revision appeared in 2015 ("ATA 2015"). These guidelines were developed predominantly by North American experts. European experts frequently have different perspectives, given epidemiological, technological/methodological, practice organization, and medicolegal differences between the respective regions.

CONCLUSIONS: European panelists suggested modifications to approximately one-third of ATA 2015 recommendations. Varying European and ATA 2015 perspectives can stimulate analysis and discussion of literature and performance of primary research to resolve discrepant recommendations and potentially improve patient outcomes.

SUMMARY: Divergent viewpoints were the focus of an invited symposium organized by the European Association of Nuclear Medicine involving 17 European thyroidologists, 4 ATA Guidelines Taskforce members, and an audience of 200 international experts. The group discussed "preoperative assessment of thyroid nodules," "surgery and role of pathology," "radioiodine therapy (RAIT)," "assessment of initial therapy and dynamic risk stratification," and "treatment of persistent disease, recurrences, and advanced thyroid cancer." The dialogue resulted in this position paper contrasting European and ATA 2015 perspectives on key issues. One difference pertains to ATA 2015's permissiveness of lobectomy for primary tumors <=4 cm. European panelists cited preclusion of RAIT, potential need for completion thyroidectomy, frequent inability to avoid chronic thyroid hormone replacement, and limitations of supportive evidence as arguments against widely applying lobectomy. Significant divergence involved ATA 2015's guidance regarding RAIT. European panelists favored wider use of post-operative RAIT than does ATA 2015. Rationales included the modality's association with favorable patient outcomes and generally limited toxicity, and lack of high-quality evidence supporting withholding RAIT. Additionally, European panelists favored recombinant human thyrotropin in more settings than does ATA 2015, citing avoidance of hypothyroid morbidity and quality-of-life impairment, without apparent sacrifice in oncologic outcomes. Based on clinicial evidence plus theoretical advantages, European experts advocated dosimetric versus fixed-activity RAIT approaches for advanced DTC. European panelists noted that the ATA 2015 risk stratification system requires information sometimes unavailable in everyday practice. ATA 2015 recommendations regarding radioiodine-refractory DTC should consider potential palliative benefits of RAIT in patients who also have radioiodine-susceptible lesions.

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