Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies



Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent.


Six scientific Italian societies entitled to cure thyroid cancer patients (the Italian Thyroid Association, the Medical Endocrinology Association, the Italian Society of Endocrinology, the Italian Association of Nuclear Medicine and Molecular Imaging, the Italian Society of Unified Endocrine Surgery and the Italian Society of Anatomic Pathology and Diagnostic Cytology) felt the need to develop a consensus report based on significant scientific advances occurred in the field.


The document includes recommendations regarding initial evaluation of thyroid nodules, clinical and ultrasound criteria for fine-needle aspiration biopsy, initial management of thyroid cancer including staging and risk assessment, surgical management, radioiodine remnant ablation, and levothyroxine therapy, short-term and long-term follow-up strategies, and management of recurrent and metastatic disease. The objective of this consensus is to inform clinicians, patients, researchers, and health policy makers about the best strategies (and their limitations) relating to the diagnosis and treatment of differentiated thyroid cancer.

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Fig. 1



Papillary thyroid microcarcinoma


Differentiated thyroid cancer




Anti-thyroglobulin antibodies


Recombinant human TSH


Whole-body scan


Radioactive iodine




Fine-needle aspiration (cytology)


Central compartment neck dissection


Low-iodine diet


Maximum tolerated activity (of radioiodine)


No clinical evidence of lymph nodes


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Corresponding author

Correspondence to F. Pacini.

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Conflict of interest

The authors have no conflict of interest to disclose.

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This study complies with ethical standard of research. It does not involve data or treatment of human being nor animals.

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Additional information

Joint statements of six Italian societies: The Italian Thyroid Association (AIT), the Medical Endocrinology Association (AME), the Italian Society of Endocrinology (SIE), the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN), the Italian Society of Unified Endocrine Surgery (SIUEC) and the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC).

Appendix 1: Reporting form for thyroid tumors

Appendix 1: Reporting form for thyroid tumors

Gross description (macroscopic)


  • Weight (size)

  • Multinodularity/uninodularity

  • Macroscopic appearance of the nodule:

    • diameter

    • homogeneous/heterogeneous

    • tumor color

    • expansive margins/infiltrative margins

    • presence/absence of a capsule

    • solid/colloid

    • cystic-hemorrhagic regression

    • calcifications (pattern and location).

  • Site

    • right lobe

    • left lobe

    • isthmus

    • pyramidal lobe

  • Distance from thyroid capsule/surgical margins

Lymph nodes

  • Site

  • Size of the specimen

  • Gross features of the largest nodes.

Microscopic examination

Thyroid nodule

  • Capsule (present/absent)

  • Structure (colloid/sclerotic/solid)

  • Histotype

    • NIFT-P

    • Papillary

      • Classical variant

      • Follicular variant

    • Follicular

      • Minimally invasive

      • Widely invasive

    • Oncocytic

    • Poorly differentiated (insular)

    • Anaplastic

    • Medullary

    • Thyroid lymphoma

    • Secondary tumors

  • Aggressive variants of PTC:

    • hobnail (report the presence)

    • tall cells (more than 10%)

    • solid (percentage value)

    • columnar cell (more than 10%)

    • diffuse sclerosing (report the presence)

  • Capsular invasion (tumor capsule/thyroid capsule)

  • Vascular invasion (no. of vessels: 4 or more) [19]

  • Minimal muscular invasion (strap muscles)

  • Extrathyroidal invasion (subcutaneous soft tissues, larynx, trachea, esophagus, recurrent laryngeal nerve, pre-vertebral fascia, neck muscles, large vessels) [20]

  • Immunohistochemistry and molecular analysis (if performed).

Lymph nodes

  • Total number

  • Number of metastatic nodes

  • Size of the largest metastatic area within the node, micro- (< 2 mm) or macrometastases Presence of extranodal invasion [75,76,77].

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Pacini, F., Basolo, F., Bellantone, R. et al. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J Endocrinol Invest 41, 849–876 (2018).

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  • Thyroid nodules
  • Thyroid cancer
  • Thyroid surgery
  • Radioiodine