Int J Thyroidol.  2023 May;16(1):1-31. 10.11106/ijt.2023.16.1.1.

2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules

• Park YJ
• Lee EK
• Song YS
• Kang SH
• Koo BS
• Kim SW
• Na DG
• Baek SK
• Oh SW
• Lee MK
• Lee SW
• Lee YA
• Lee YS
• Lee JY
• Lim DJ
• Joo L
• Jung YS
• Jung CK
• Cho YY
• Chung YJ
• Kim WB
• Yi KH
• Kang HC
• Park DJ

• KMID: 2543006
• DOI: http://doi.org/10.11106/ijt.2023.16.1.1

Abstract

Thyroid nodules are a prevalent condition that can be detected through palpation or ultrasound. However, a small fraction of these nodules can be cancerous, and even benign nodules can cause symptoms if they grow and compress surrounding tissue. As such, it is important to monitor thyroid nodules and determine appropriate treatment options. In recent years, there has been a shift towards enhancing diagnostic accuracy and less aggressive treatment options. As a result, there is a growing need for the development of appropriate recommendations for their clinical application to ensure optimal patient outcomes. The present clinical practice guideline was developed by extracting the nodule section from the prior version of guidelines and updating it to fit the Korean circumstances. Task force members reviewed relevant studies selected after electronic database searching, and the recommendations are provided with a level of recommendation for each section. The revised guideline includes recommendations for thyroid cancer screening in high-risk groups, appropriate diagnostic methods for thyroid nodules, the role of pathological and molecular marker tests in diagnosis, long-term follow-up and treatment of benign thyroid nodules, and special considerations for pregnant women. The major changes in this revision are the definition of high-risk groups for thyroid cancer screening, the application of the revised Korean Thyroid Imaging Reporting and Data System (K-TIRADS), the addition of the role of core needle biopsy and molecular marker tests, the application of active surveillance in low-risk papillary thyroid microcarcinoma, and updated indications for non-surgical treatment of benign thyroid nodules. These evidence-based recommendations are expected to assist in clinical decision-making for thyroid nodule management, ensuring that patients receive the most appropriate and effective treatment options.

Keyword

Thyroid nodule; Guideline; Diagnosis; Treatment

Figure

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  Fig. 1 갑상선결절에 대한 검사 및 치료 알고리즘. a갑상선중독증의 원인 질환에 대한 추가적인 검사 및 치료가 필요할 수 있다. b초음파 소견이 있는 경우에는 이에 따라 병리진단검사 시행 여부를 결정한다. c병리진단검사로는 세침흡인검사(FNA)가 정확하고, 비용 대비 효율이 가장 큰 방법으로 일차적으로 권고된다. 중심바늘생검(CNB)은 FNA의 보완적 수단으로서 숙련된 시술자에 의해 선택적으로 고려할 수 있다. TSH가 증가된 경우에는 기능저하증에 대한 진단 및 치료를 병행한다. d병리진단결과에 보조적으로 악성 위험도를 계층화하기 위해 면역화학염색검사, 단일유전자변이검사 및 차세대염기서열을 기반으로 하는 유전자패널검사가 고려될 수 있다. e저위험군의 미세갑상선유두암 등에서는 임상상과 환자 선호도 등을 고려하여 즉각적인 수술 대신 면밀한 적극적 관찰(active surveillance)을 고려할 수 있다.

Reference

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