Clinical Practice Guidelines for Thyroid Cancer: Where Are We Now?

Clinical practice guidelines (CPG) are systematically developed statements that assist physicians in clinical decision making. The development of CPG has evolved over the last several decades and incorporates evidence-based medicine (EBM). Since 2003, at least seven CPG have been developed that focus on aspects of thyroid cancer evaluation and management. There are many commonalities among these CPG: clinical risk stratification, nodule risk stratification, treatment algorithms for intermediate-risk scenarios, and follow-up algorithms commensurate with risk stratification. However, there are also divergences and “fuzzy” areas in the CPG. Although these might be accounted for by differences in, or absence of, EBM methodology, they most likely reflect knowledge gaps. These fuzzy areas are principally in the low-risk patient, where “watchful waiting” is an option, and the high-risk patient recalcitrant to conventional therapy, where novel diagnostic tools and therapies are needed. Emergent biotechnologies may clarify these fuzzy areas and generate a new brand of thyroid cancer CPG. Among these emergent biotechnologies, molecular medicine holds the greatest promise.