The UK Evidence-Based Guidelines for the Management of Thyroid Cancer: Key Recommendations

  • Maria G. Pavlatou
  • Sarah J. Johnson
  • Petros Perros


A review of the most important recommendations of the latest edition of the UK British Thyroid Association guidelines for the management of thyroid nodules and differentiated thyroid cancer is presented here. A notable trend in the UK guidelines has been an increasing focus towards a more individualized approach and less aggressive treatments for indolent tumors. The current guidelines also emphasize the role of high-resolution ultrasound on the initial stratification and long-term management of the thyroid nodules and introduce a three-tiered clinico-pathologic risk stratification system and the concept of dynamic risk stratification to provide an individualized approach to ongoing management. Overall, these guidelines aim to optimize long-term outcomes in patients with thyroid neoplasms, offering the most appropriate treatment to high-risk individuals while avoiding overtreatment of those at low risk, taking into consideration the importance of maintaining patient quality of life.


Thyroid nodule Differentiated thyroid cancer Individualized treatment Dynamic risk stratification Ongoing management 


  1. 1.
    Teppo L, Hakulinen E, Eurocare Working Group. Variation in survival of adult patients with thyroid cancer in Europe. Eur J Cancer. 1998;34:2238–52.CrossRefGoogle Scholar
  2. 2.
    Mallick UK, Ball S, Fenwick JD, James RA, Johnson SJ, Lennard TWJ, Lucraft HH, Proud G, Perros P, Weightman DR. Northern cancer network guidelines for management of thyroid cancer. Clin Oncol. 2000;12:373–91.Google Scholar
  3. 3.
    Kendall-Taylor P, Beckett GJ, Clark, Clarke EM, Collins R, Farndon J, Franklyn J, Owen Hafiz C, Harmer C, GAW H, Kabala J, Lawrence J, AM MN, Mallick UK, Ponder B, Prentice M, Proud G, Sturgeon C, Watkinson J, Weetman AP, Williams J, Vini L. Guidelines for the management of thyroid cancer in adults. London: RCP; 2002.Google Scholar
  4. 4.
    Perros P, Clarke SEM, Franklyn J, Gerrard G, Harrison B, Hickey J, Kendall-Taylor P, McNicol AM, Mallick UK, Prentice M, Thakker RV, Watkinson J, Weetman AP. Guidelines for the management of thyroid cancer. 2nd ed. London: RCP; 2007.Google Scholar
  5. 5.
    Perros P, Boelaert K, Colley S, Evans C, Evans R, Gerrard B, Gilbert J, Harrison B, Johnson S, Giles T, Moss L, Lewington V, Newbold K, Taylor J, Thakker R, Watkinson J, Williams G, Thyroid B. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014;81:1–122.CrossRefGoogle Scholar
  6. 6.
    Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM. Importance of clarifying patients’ desired role in shared decision making to match their level of engagement with their preferences. BMJ. 2013;347:f7066.CrossRefGoogle Scholar
  7. 7.
    Guth S, Theune U, Aberle J, Galach A, Bamberger C. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Investig. 2009;39:699–706.CrossRefGoogle Scholar
  8. 8.
    Aschebrook-Kilfoy B, Schechter RB, Shih YC, Kaplan EL, Chiu BC, Angelos P, Grogan RH. The clinical and economic burden of a sustained increase in thyroid cancer incidence. Cancer Epidemiol Biomark Prev. 2013;22:1252–9.CrossRefGoogle Scholar
  9. 9.
    Vaccarella S, Franceschi S, Bray F, Wild C, Plummer M, Dal Maso L. Worldwide thyroid-Cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375:614–7.CrossRefGoogle Scholar
  10. 10.
    Smith-Bindman R, Lebda P, Feldstein V, Sellami D, Goldstein R, Brasic N, Jin C, Kornak J. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013;173:1788–96.CrossRefGoogle Scholar
  11. 11.
    Horvath E, Majilis S, Rossi R, Franco C, Nied- mann J, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;90:1748–51.CrossRefGoogle Scholar
  12. 12.
    Hambly N, Gonen M, Gerst S, Li D, Jia X, Mironov S, Sarasohn D, Fleming S, Hann L. Implementation of evidence-based guidelines for thyroid nodule biopsy: a model for establishment of practice standards. AJR Am J Roentgenol. 2011;196:655–60.CrossRefGoogle Scholar
  13. 13.
    Lee Y, Kim D, In H, Park J, Kim S, Eom J, Kim B, Lee E, Rho M. Differentiation between benign and malignant solid thyroid nodules using an US classification system. Korean J Radiol. 2011;12:559–67.CrossRefGoogle Scholar
  14. 14.
    Moon W, Jung S, Lee J, Na D, Baek J, Lee Y, Kim J, Kim H, Byun J, Lee D, Study T. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008;247:762–70.CrossRefGoogle Scholar
  15. 15.
    Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res. 2013;181:6–10.CrossRefGoogle Scholar
  16. 16.
    Mehanna R, Murphy M, McCarthy J, O'Leary G, Tuthill A, Murphy MS, Sheahan P. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope. 2013;123:1305–9.CrossRefGoogle Scholar
  17. 17.
    Shi H, Bobanga I, McHenry CR. Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer? Am J Surg. 2017;213:464–6.CrossRefGoogle Scholar
  18. 18.
    Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid. 2012;22:1251–6.CrossRefGoogle Scholar
  19. 19.
    The Royal College of Pathologists. Guidance on the reporting of thyroid cytology specimens. London: The Royal College of Pathologists; 2016.Google Scholar
  20. 20.
    Poller DN, Baloch ZW, Fadda G, Johnson SJ, Bongiovanni M, Pontecorvi A, Cochand-Priollet B. Thyroid FNA: new classifications and new interpretations. Cancer Cytopathol. 2016;124:457–66. Scholar
  21. 21.
    Gerhard R, Boerner SL. The value of second opinion in thyroid cytology: a review. Cancer Cytopathol. 2014;122:611–9.CrossRefGoogle Scholar
  22. 22.
    Kocjan G, Chandra A, Cross PA, et al. The interobserver reproducibility of thyroid fine-needle aspiration using the UK Roal College of Pathologists classification system. Am J Clin Pathol. 2011;135:852–9.CrossRefGoogle Scholar
  23. 23.
    Parkinson D, Aziz S, Bentley R, Johnson SJ. Thyroid cytology-histology correlation using the RCPath terminology for thyroid cytology reporting. J Clin Pathol. 2017;70(8):648–55. Scholar
  24. 24.
    The Royal College of Pathologists. Dataset for thyroid cancer histopathology reports. London: The Royal College of Pathologists; 2014.Google Scholar
  25. 25.
    Poller D, Johnson SJ. Recent developments in the pathology of thyroid cancer. Clin Oncol (R Coll Radiol). 2017;29(5):278–82. Scholar
  26. 26.
    Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LDR, Barletta JA, Wenig BM, Al Ghuzlan A, Kakudo K, Giordano TJ, Alves VA, Khanafshar E, Asa SL, El-Naggar AK, Gooding WE, Hodak SP, Lloyd RV, Maytal G, Mete O, Nikiforova MN, Nosé V, Papotti M, Poller DN, Sadow PM, Tischler AS, Tuttle RM, Wall KB, VA LV, Randolph GW, Ghossein RA. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2(8):1023–9. Scholar
  27. 27.
    Brierley JD, Gospodarowicz MK, Wittekind C, for UICC, editors. The TNM classification of malignant tumours. 8th ed. Chichester: Wiley-Blackwell; 2016.Google Scholar
  28. 28.
    Hay ID, McConahey WM, Goellner JR. Managing patients with papillary thyroid carcinoma: insights gained from the Mayo Clinic’s experience of treating 2,512 consecutive patients during 1940 through 2000. Trans Am Clin Climatol Assoc. 2002;113:241–60.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Matsuzu K, Sugino K, Masudo K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, Uruno T, Suzuki A, Magoshi S, Akaishi J, Masaki C, Kawano M, Suganuma N, Rino Y, Masuda M, Kameyama K, Takami H, Ito K. Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J Surg. 2013;38:68–79.CrossRefGoogle Scholar
  30. 30.
    Nixon I, Ganly I, Patel S, Palmer F, Whitcher M, Tuttle R, Shaha A, Shah J. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2011;151:571–9.CrossRefGoogle Scholar
  31. 31.
    Hassanain M, Wexler M. Conservative management of well-differentiated thyroid cancer. Can J Surg. 2010;53:109–18.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Mendelsohn AH, Elashoff DA, Abemayor E, St John MA. Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg. 2010;136:1055–61.CrossRefGoogle Scholar
  33. 33.
    Cooper D, Doherty G, Haugen B, Kloos R, Lee S, Mandel S, Mazzaferri E, McIver B, Pacini F, Schlumberger M, Sherman S, Steward D, Tuttle R. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.CrossRefGoogle Scholar
  34. 34.
    Tuttle R, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, Brokhin M, Omry G, Fagin J, Shaha A. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20:1341–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maria G. Pavlatou
    • 1
  • Sarah J. Johnson
    • 2
  • Petros Perros
    • 1
  1. 1.Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne HospitalsNHS Foundation TrustNewcastle upon TyneUK
  2. 2.Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne HospitalsNHS Foundation TrustNewcastle upon TyneUK

Personalised recommendations