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Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

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Abstract

Aim: 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.

Conclusion: 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.

Keywords: Thyroid nodule, thyroidectomy, hemi-thyroidectomy, ablation, thermo-ablation, radiofrequency, laser, microwave, HIFU, ultrasound, ethanol injection.

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[1]
Tessler, F.N.; Middleton, W.D.; Grant, E.G. Thyroid imaging reporting and data system (TI-RADS): A user’s guide. Radiology, 2018, 287(1), 29-36.
[http://dx.doi.org/10.1148/radiol.2017171240] [PMID: 29558300]
[2]
Haugen, B.R.; Alexander, E.K.; Bible, K.C.; Doherty, G.M.; Mandel, S.J.; Nikiforov, Y.E.; Pacini, F.; Randolph, G.W.; Sawka, A.M.; Schlumberger, M.; Schuff, K.G.; Sherman, S.I.; Sosa, J.A.; Steward, D.L.; Tuttle, R.M.; Wartofsky, L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1), 1-133.
[http://dx.doi.org/10.1089/thy.2015.0020] [PMID: 26462967]
[3]
Gharib, H.; Papini, E.; Garber, J.R.; Duick, D.S.; Harrell, R.M.; Hegedüs, L.; Paschke, R.; Valcavi, R.; Vitti, P. AACE, ACE and AME Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr. Pract., 2016, 22, 622-639.
[http://dx.doi.org/10.4158/EP161208.GL] [PMID: 27167915]
[4]
Durante, C.; Grani, G.; Lamartina, L.; Filetti, S.; Mandel, S.J.; Cooper, D.S. The diagnosis and management of thyroid nodules: A review. JAMA, 2018, 319(9), 914-924.
[http://dx.doi.org/10.1001/jama.2018.0898] [PMID: 29509871]
[5]
Ho, T.W.T.; Shaheen, A.A.; Dixon, E.; Harvey, A. Utilization of thyroidectomy for benign disease in the United States: A 15-year population-based study. Am. J. Surg., 2011, 201(5), 570-574.
[http://dx.doi.org/10.1016/j.amjsurg.2010.12.006] [PMID: 21545901]
[6]
Sun, G.H.; DeMonner, S.; Davis, M.M. Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006. Thyroid, 2013, 23(6), 727-733.
[http://dx.doi.org/10.1089/thy.2012.0218] [PMID: 23173840]
[7]
Mathonnet, M.; Cuerq, A.; Tresallet, C.; Thalabard, J.C.; Fery-Lemonnier, E.; Russ, G.; Leenhardt, L.; Bigorgne, C.; Tuppin, P.; Millat, B.; Fagot-Campagna, A. What is the care pathway of patients who undergo thyroid surgery in France and its potential pitfalls? A national cohort. BMJ Open, 2017, 7(4), e013589.
[http://dx.doi.org/10.1136/bmjopen-2016-013589] [PMID: 28389487]
[8]
Bartsch, D.; Dotzenrath, C.; Vorländer, C.; Zielke, A.; Weber, T.; Buhr, H.; Klinger, C.; Lorenz, K. Current practice of surgery for benign goitre - An analysis of the prospective DGAV StuDoQ|Thyroid Registry. J. Clin. Med., 2019, 8(4), 477-486.
[http://dx.doi.org/10.3390/jcm8040477] [PMID: 30965665]
[9]
Russ, G.; Bonnema, S.J.; Erdogan, M.F.; Durante, C.; Ngu, R.; Leenhardt, L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur. Thyroid J., 2017, 6(5), 225-237.
[http://dx.doi.org/10.1159/000478927] [PMID: 29167761]
[10]
Rago, T.; Cantisani, V.; Ianni, F.; Chiovato, L.; Garberoglio, R.; Durante, C.; Frasoldati, A.; Spiezia, S.; Farina, R.; Vallone, G.; Pontecorvi, A.; Vitti, P. Thyroid ultrasonography reporting: Consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM). J. Endocrinol. Invest., 2018, 41(12), 1435-1443.
[http://dx.doi.org/10.1007/s40618-018-0935-8] [PMID: 30327945]
[11]
Pacini, F.; Basolo, F.; Bellantone, R.; Boni, G.; Cannizzaro, M.A.; De Palma, M.; Durante, C.; Elisei, R.; Fadda, G.; Frasoldati, A.; Fugazzola, L.; Guglielmi, R.; Lombardi, C.P.; Miccoli, P.; Papini, E.; Pellegriti, G.; Pezzullo, L.; Pontecorvi, A.; Salvatori, M.; Seregni, E.; Vitti, P. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J. Endocrinol. Invest., 2018, 41(7), 849-876. Available from: https://link.springer.com/article/10.1007/s40618-018-0884-2
[http://dx.doi.org/10.1007/s40618-018-0884-2] [PMID: 29729004]
[12]
Hegedüs, L. Clinical practice. The thyroid nodule. N. Engl. J. Med., 2004, 351(17), 1764-1771.
[http://dx.doi.org/10.1056/NEJMcp031436] [PMID: 15496625]
[13]
Tessler, F.N.; Middleton, W.D.; Grant, E.G.; Hoang, J.K.; Berland, L.L.; Teefey, S.A.; Cronan, J.J.; Beland, M.D.; Desser, T.S.; Frates, M.C.; Hammers, L.W.; Hamper, U.M.; Langer, J.E.; Reading, C.C.; Scoutt, L.M.; Stavros, A.T. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J. Am. Coll. Radiol., 2017, 14(5), 587-595.
[http://dx.doi.org/10.1016/j.jacr.2017.01.046] [PMID: 28372962]
[14]
Cibas, E.S.; Ali, S.Z. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid, 2017, 27(11), 1341-1346.
[http://dx.doi.org/10.1089/thy.2017.0500] [PMID: 29091573]
[15]
Nardi, F.; Basolo, F.; Crescenzi, A.; Fadda, G.; Frasoldati, A.; Orlandi, F.; Palombini, L.; Papini, E.; Zini, M.; Pontecorvi, A.; Vitti, P. Italian consensus for the classification and reporting of thyroid cytology. J. Endocrinol. Invest., 2014, 37(6), 593-599.
[http://dx.doi.org/10.1007/s40618-014-0062-0] [PMID: 24789536]
[16]
Kandil, E.; Krishnan, B.; Noureldine, S.I.; Yao, L.; Tufano, R.P. Hemithyroidectomy: A meta-analysis of postoperative need for hormone replacement and complications. ORL J. Otorhinolaryngol. Relat. Spec., 2013, 75(1), 6-17.
[http://dx.doi.org/10.1159/000345498] [PMID: 23486083]
[17]
Liang, T.J.; Liu, S.I.; Mok, K.T.; Shi, H.Y. Associations of volume and thyroidectomy outcomes: a nationwide study with systematic review and meta-analysis. Otolaryngol. Head Neck Surg., 2016, 155(1), 65-75.
[http://dx.doi.org/10.1177/0194599816634627] [PMID: 26932961]
[18]
Al-Qurayshi, Z.; Robins, R.; Hauch, A.; Randolph, G.W.; Kandil, E. Association of surgeon volume with outcomes and cost savings following thyroidectomy. A national forecast. JAMA Otolaryngol. Head Neck Surg., 2016, 142(1), 32-39.
[http://dx.doi.org/10.1001/jamaoto.2015.2503] [PMID: 26561736]
[19]
Aspinall, S.; Oweis, D.; Chadwick, D. Effect of surgeons’ annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS). Langenbecks Arch. Surg., 2019, 404(4), 421-430.
[http://dx.doi.org/10.1007/s00423-019-01798-7] [PMID: 31254103]
[20]
Lorenz, K.; Raffaeli, M.; Barczyński, M.; Lorente-Poch, L.; Sancho, J. Volume, outcomes, and quality standards in thyroid surgery: an evidence based analysis—European Society of Endocrine Surgeons (ESES) positional statement. Langenbecks Arch. Surg., 2020, 405(4), 401-425.
[http://dx.doi.org/10.1007/s00423-020-01907-x] [PMID: 32524467]
[21]
Papini, E.; Monpeyssen, H.; Frasoldati, A.; Hegedüs, L. 2020 European Thyroid Association clinical practice guideline for the use of image-guided ablation in benign thyroid nodules. Eur. Thyroid J., 2020, 9(4), 172-185.
[http://dx.doi.org/10.1159/000508484] [PMID: 32903999]
[22]
Guglielmi, R.; Pacella, C.M.; Bianchini, A.; Bizzarri, G.; Rinaldi, R.; Graziano, F.M.; Petrucci, L.; Toscano, V.; Palma, E.; Poggi, M.; Papini, E. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid, 2004, 14(2), 125-131.
[http://dx.doi.org/10.1089/105072504322880364] [PMID: 15068627]
[23]
Cesareo, R.; Tabacco, G.; Naciu, A.M. Long-term efficacy and safety of percutaneous ethanol injection (PEI) in cystic thyroid nodules: A systematic review and meta-analysis. Clin. Endocrinol., 2022, 96(2), 97-106.
[http://dx.doi.org/10.1111/cen.14530] [PMID: 34028855]
[24]
Pacella, C.M.; Mauri, G.; Achille, G.; Barbaro, D.; Bizzarri, G.; De Feo, P.; Di Stasio, E.; Esposito, R.; Gambelunghe, G.; Misischi, I.; Rag-giunti, B.; Rago, T.; Patelli, G.L.; D’Este, S.; Vitti, P.; Papini, E. Outcomes and risk factors for complications of laser ablation for thyroid nodules: A multicenter study on 1531 patients. J. Clin. Endocrinol. Metab., 2015, 100(10), 3903-3910.
[http://dx.doi.org/10.1210/jc.2015-1964] [PMID: 26274342]
[25]
Cesareo, R.; Pasqualini, V.; Simeoni, C.; Sacchi, M.; Saralli, E.; Campagna, G.; Cianni, R. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J. Clin. Endocrinol. Metab., 2015, 100(2), 460-466.
[http://dx.doi.org/10.1210/jc.2014-2186] [PMID: 25387256]
[26]
Deandrea, M.; Sung, J.Y.; Limone, P.; Mormile, A.; Garino, F.; Ragazzoni, F.; Kim, K.S.; Lee, D.; Baek, J.H. Efficacy and safety of radiofrequency ablation versus observation for nonfunctioning benign thyroid nodules: A randomized controlled international collaborative trial. Thyroid, 2015, 25(8), 890-896.
[http://dx.doi.org/10.1089/thy.2015.0133] [PMID: 26061686]
[27]
Orloff, L.A.; Noel, J.E.; Stack, B.C., Jr; Russell, M.D.; Angelos, P.; Baek, J.H.; Brumund, K.T.; Chiang, F.Y.; Cunnane, M.B.; Davies, L.; Frasoldati, A.; Feng, A.Y.; Hegedüs, L.; Iwata, A.J.; Kandil, E.; Kuo, J.; Lombardi, C.; Lupo, M.; Maia, A.L.; McIver, B.; Na, D.G.; Novizio, R.; Papini, E.; Patel, K.N.; Rangel, L.; Russell, J.O.; Shin, J.; Shindo, M.; Shonka, D.C., Jr; Karcioglu, A.S.; Sinclair, C.; Singer, M.; Spiezia, S.; Steck, J.H.; Steward, D.; Tae, K.; Tolley, N.; Valcavi, R.; Tufano, R.P.; Tuttle, R.M.; Volpi, E.; Wu, C.W.; Abdelhamid Ahmed, A.H.; Randolph, G.W. Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck, 2022, 44(3), 633-660.
[http://dx.doi.org/10.1002/hed.26960] [PMID: 34939714]
[28]
Wu, W.; Gong, X.; Zhou, Q.; Chen, X.; Chen, X.; Shi, B. US-guided percutaneous microwave ablation for the treatment of benign thyroid nodules. Endocr. J., 2017, 64(11), 1079-1085.
[http://dx.doi.org/10.1507/endocrj.EJ17-0152] [PMID: 28855431]
[29]
Liu, Y.J.; Qian, L.X.; Liu, D.; Zhao, J.F. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Exp. Biol. Med., 2017, 242(15), 1515-1523.
[http://dx.doi.org/10.1177/1535370217727477] [PMID: 28847173]
[30]
Lang, B.H.H.; Wu, A.L.H. High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review. J. Ther. Ultrasound, 2017, 5(1), 11.
[http://dx.doi.org/10.1186/s40349-017-0091-1] [PMID: 28523127]
[31]
Papini, E.; Petrucci, L.; Guglielmi, R.; Panunzi, C.; Rinaldi, R.; Bacci, V.; Crescenzi, A.; Nardi, F.; Fabbrini, R.; Pacella, C.M. Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J. Clin. Endocrinol. Metab., 1998, 83(3), 780-783.
[http://dx.doi.org/10.1210/jcem.83.3.4615] [PMID: 9506726]
[32]
Grussendorf, M.; Reiners, C.; Paschke, R.; Wegscheider, K. Reduction of thyroid nodule volume by levothyroxine and iodine alone and in combination: a randomized, placebo-controlled trial. J. Clin. Endocrinol. Metab., 2011, 96(9), 2786-2795.
[http://dx.doi.org/10.1210/jc.2011-0356] [PMID: 21715542]
[33]
Fast, S.; Bonnema, S.J.; Hegedüs, L. The majority of Danish nontoxic goitre patients are ineligible for Levothyroxine suppressive therapy. Clin. Endocrinol., 2008, 69(4), 653-658.
[http://dx.doi.org/10.1111/j.1365-2265.2008.03241.x] [PMID: 18363890]
[34]
Bonnema, S.J.; Nielsen, V.E.; Hegedüs, L. Long-term effects of radioiodine on thyroid function, size and patient satisfaction in non-toxic diffuse goitre. Eur. J. Endocrinol., 2004, 150(4), 439-445.
[http://dx.doi.org/10.1530/eje.0.1500439] [PMID: 15080772]
[35]
Mannucci, E.; Candido, R.; Monache, L.; Gallo, M.; Giaccari, A.; Masini, M.L.; Mazzone, A.; Medea, G.; Pintaudi, B.; Targher, G.; Trento, M.; Turchetti, G.; Lorenzoni, V.; Monami, M. Italian guidelines for the treatment of type 2 diabetes. Acta Diabetol., 2022, 59(5), 579-622.
[http://dx.doi.org/10.1007/s00592-022-01857-4] [PMID: 35288805]
[36]
Higgins, J.P.T.; Altman, D.G.; Gøtzsche, P.C.; Jüni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.C. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343(oct18 2), d5928.
[http://dx.doi.org/10.1136/bmj.d5928] [PMID: 22008217]
[37]
Wells, G.A.; Shea, B.; O’Connell, D. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Metaanalyses, Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
[38]
Technical commission for public finance. Green Paper on Public Expenditure; Ministry of Economy and Finance, 2007. Available from: http://www.astrid-online.it/static/upload/protected/Libr/Libro_Verde_Spesa_Pubblica.pdf
[39]
Ministero della Salute. Nomenclatore dell’Assistenza Specialistica Ambulatoriale. 2017. Available from: https://www.salute.gov.it/portale/temi/p2_6.jsp?id=1767&area=programmazioneSanitariaLea& menu=lea
[40]
AIFA. Transparency List, Class H Drugs, Available from: https://www.aifa.gov.it/liste-di-trasparenza
[41]
Statistics. Available from: https://www.aranagenzia.it/statistiche-e-pubblicazioni/dati-statistici.html
[42]
Rossitto, C.; Gueli Alletti, S.; Romano, F.; Fiore, A.; Coretti, S.; Oradei, M.; Ruggeri, M.; Cicchetti, A.; Marchetti, M.; Fanfani, F.; Scambia, G. Use of robot-specific resources and operating room times: the case of Telelap Alf-X robotic hysterectomy. Int. J. Med. Robot., 2016, 12(4), 613-619.
[http://dx.doi.org/10.1002/rcs.1724] [PMID: 26748491]
[43]
Job Pricing: All About Rewards – Salary Outlook 2019: Analysis of the Italian salary market – data updated to the second half of 2018. 2019. Available from: https://www.jobpricing.it/blog/project/salary-outlook-2019-prima-edizione/
[44]
Ruggeri, M.; Basile, M.; Armuzzi, A.; Cicchetti, A. Activity-based costing and budget analysis of vedolizumab versus conventional treatments in ulcerative colitis and Crohn’s disease. Glob. Reg. Health Technol. Assess., 2017, 4, e88-e99.
[http://dx.doi.org/10.33393/grhta.2017.382]
[45]
Sancho, J.J.; Prieto, R.; Dueñas, J.P.; Ribera, C.; Ripollés, J.; Larrad, Á.; Sitges-Serra, A. A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter. Ann. Surg., 2012, 256(5), 846-852.
[http://dx.doi.org/10.1097/SLA.0b013e318272df62] [PMID: 23095630]
[46]
Zhi, X.; Zhao, N.; Liu, Y.; Liu, J.B.; Teng, C.; Qian, L. Microwave ablation compared to thyroidectomy to treat benign thyroid nodules. Int. J. Hyperthermia, 2018, 34(5), 644-652.
[http://dx.doi.org/10.1080/02656736.2018.1456677] [PMID: 29577796]
[47]
Cossu, M.L.; Palermo, M.; Coppola, M.; Fais, E.; Ruggiu, M.; Noya, G. Total thyroidectomy in surgical treatment of euthyroid goiter. Minerva Chir., 1999, 54(12), 859-862.https://www.minervamedica.it/it/riviste/minerva-surgery/articolo.php?cod=R06Y1999N12A0859
[PMID: 10736991]
[48]
Mourad, M.; Saab, N.; Malaise, J.; Ngongang, C.; Fournier, B.; Daumerie, C.; Squifflet, J.P. Minimally invasive video-assisted approach for partial and total thyroidectomy. Surg. Endosc., 2001, 15(10), 1108-1111.
[http://dx.doi.org/10.1007/s004640090018] [PMID: 11727080]
[49]
Scerrino, G.; Salamone, G.; Farulla, M.A.; Romano, G.; Salamone, S.; Pompei, G.; Buscemi, G. Non-toxic multinodular goitre: Which surgery? Ann. Ital. Chir., 2001, 72(6), 647-651.https://www.annaliitalianidichirurgia.it/prodotto/il-gozzo-multinodulare-non-tossico-quale-chirurgia/
[PMID: 12061215]
[50]
Vaiman, M.; Nagibin, A.; Hagag, P.; Kessler, A.; Gavriel, H. Hypothyroidism following partial thyroidectomy. Otolaryngol. Head Neck Surg., 2008, 138(1), 98-100.
[http://dx.doi.org/10.1016/j.otohns.2007.09.015] [PMID: 18165001]
[51]
Vaiman, M.; Nagibin, A.; Olevson, J. Complications in primary and completed thyroidectomy. Surg. Today, 2010, 40(2), 114-118.
[http://dx.doi.org/10.1007/s00595-008-4027-9] [PMID: 20107949]
[52]
Simsek Celik, A.; Erdem, H.; Guzey, D.; Celebi, F.; Celik, A.; Birol, S.; Kaplan, R. The factors related with postoperative complications in benign nodular thyroid surgery. Indian J. Surg., 2011, 73(1), 32-36.
[http://dx.doi.org/10.1007/s12262-010-0172-7] [PMID: 22211035]
[53]
Yue, W.W.; Wang, S.R.; Lu, F.; Li, X-L.; Xu, H-X.; Sun, L.P.; Guo, L.H.; He, Y.P.; Wang, D.; Yin, Z.Q. Quality of life and cost-effectiveness of radiofrequency ablation versus open surgery for benign thyroid nodules: a retrospective cohort study. Sci. Rep., 2016, 6(1), 37838.
[http://dx.doi.org/10.1038/srep37838] [PMID: 27883069]
[54]
Lang, B.H.H.; Wong, C.K.H.; Ma, E.P.M. Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int. J. Hyperthermia, 2017, 33(8), 1-7.
[http://dx.doi.org/10.1080/02656736.2017.1305127] [PMID: 28540785]
[55]
Dong, P.; Wu, X.L.; Sui, G.Q.; Luo, Q.; Du, J.R.; Wang, H.; Teng, D.K. The efficacy and safety of microwave ablation versus lobectomy for the treatment of benign thyroid nodules greater than 4 cm. Endocrine, 2021, 71(1), 113-121.
[http://dx.doi.org/10.1007/s12020-020-02338-w] [PMID: 32419083]
[56]
Bauer, P.S.; Murray, S.; Clark, N.; Pontes, D.S.; Sippel, R.S.; Chen, H. Unilateral thyroidectomy for the treatment of benign multinodular goiter. J. Surg. Res., 2013, 184(1), 514-518.
[http://dx.doi.org/10.1016/j.jss.2013.04.045] [PMID: 23688788]
[57]
Lang, B.H.H.; Wong, C.K.H.; Ma, E.P.M.; Woo, Y.C.; Chiu, K.W.H. A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Surgery, 2019, 165(1), 85-91.
[http://dx.doi.org/10.1016/j.surg.2018.05.080] [PMID: 30392858]
[58]
Tabriz, N.; Uslar, V.N.; Tabriz, I.; Weyhe, D. Quality of life is not affected by thyroid surgery in nontoxic benign goitre in longterm surveillance-A prospective observational study. Endocrinol. Diabetes Metab., 2020, 3(2), e00115.
[http://dx.doi.org/10.1002/edm2.115] [PMID: 32318633]
[59]
Istituto Superiore di Sanità. Guideline on the management of benign, locally symptomatic thyroid nodule. Italian National System for Guidelines. n 174, 2022. Available from: https://snlg.iss.it/wp-content/uploads/2022/04/LG174-AME_Nodulo-tiroideo-benigno.pdf
[60]
Pierannunzio, D.; Fedeli, U.; Francisci, S.; Paoli, A.D.; Toffolutti, F.; Serraino, D.; Zoppini, G.; Borsatti, E.; Di Felice, E.; Falcini, F.; Ferretti, S.; Giorgi Rossi, P.; Gobitti, C.; Guzzinati, S.; Mattioli, V.; Mazzoleni, G.; Piffer, S.; Vaccarella, S.; Vicentini, M.; Zorzi, M.; Franceschi, S.; Elisei, R.; Dal Maso, L. Thyroidectomies in Italy: A population-based national analysis from 2001 to 2018. Thyroid, 2022, 32(3), 263-272.
[http://dx.doi.org/10.1089/thy.2021.0531] [PMID: 35018816]

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