PDF(Pubmed)
Abstract：
OBJECTIVE: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy.
METHODS: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as \"critical\" and \"important\" were considered in the systematic review of evidence and only those classified as \"critical\" were considered in the formulation of recommendations.
RESULTS: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists.
CONCLUSIONS: The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated.
METHODS: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as \"critical\" and \"important\" were considered in the systematic review of evidence and only those classified as \"critical\" were considered in the formulation of recommendations.
RESULTS: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists.
CONCLUSIONS: The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated.
摘要：
目的：本指南（GL）旨在为无功能的管理提供参考，良性甲状腺结节在妊娠以外的成年人中引起局部症状。
方法：本GL是按照国家指南系统手册中描述的方法开发的。对于每个问题,由Medici内分泌学协会（AME）任命的小组确定了潜在的相关结局，然后对它们对治疗选择的影响进行评级。只有分类为“关键”和“重要”的结果在系统评价证据中被考虑，只有那些分类为“关键”的结果在制定建议时被考虑。
结果：本GL包含关于手术和微创治疗在良性症状甲状腺结节治疗中各自作用的建议。我们建议半甲状腺切除术加峡部切除术作为首选手术治疗方法，前提是对侧甲状腺叶中不存在临床重大疾病。对于对侧甲状腺叶有临床意义的患者，应考虑进行甲状腺全切除术。对于有症状的患者，我们建议考虑将热消融作为手术的替代选择，固体,良性,单身,或显性甲状腺结节。这些建议适用于门诊患者，无论是在初级保健中，还是在转诊给专家时。
结论：目前的GL是针对内分泌学家，外科医生,和在医院工作的介入放射科医生，在领土服务中，或者私人执业，全科医生,和病人。现有数据表明，实施本GL建议将导致良性甲状腺结节性疾病的外科手术逐渐减少，减少非恶性疾病的外科住院人数，并更快地接触甲状腺癌患者。重要的是,由于长期替代治疗和手术并发症的处理,间接成本的降低也有可能被推测.
方法：本GL是按照国家指南系统手册中描述的方法开发的。对于每个问题,由Medici内分泌学协会（AME）任命的小组确定了潜在的相关结局，然后对它们对治疗选择的影响进行评级。只有分类为“关键”和“重要”的结果在系统评价证据中被考虑，只有那些分类为“关键”的结果在制定建议时被考虑。
结果：本GL包含关于手术和微创治疗在良性症状甲状腺结节治疗中各自作用的建议。我们建议半甲状腺切除术加峡部切除术作为首选手术治疗方法，前提是对侧甲状腺叶中不存在临床重大疾病。对于对侧甲状腺叶有临床意义的患者，应考虑进行甲状腺全切除术。对于有症状的患者，我们建议考虑将热消融作为手术的替代选择，固体,良性,单身,或显性甲状腺结节。这些建议适用于门诊患者，无论是在初级保健中，还是在转诊给专家时。
结论：目前的GL是针对内分泌学家，外科医生,和在医院工作的介入放射科医生，在领土服务中，或者私人执业，全科医生,和病人。现有数据表明，实施本GL建议将导致良性甲状腺结节性疾病的外科手术逐渐减少，减少非恶性疾病的外科住院人数，并更快地接触甲状腺癌患者。重要的是,由于长期替代治疗和手术并发症的处理,间接成本的降低也有可能被推测.
