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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2021; 04(04): 167-174
DOI: 10.4103/jdep.jdep_34_21
Original Article

Clinical practice patterns in the management of thyroid nodules: The first survey from the Middle East and Africa

Salem Beshyah
1   Department of Medicine, Dubai Medical College for Girls, Dubai
2   Yas Clinic Khalifa City, Abu Dhabi, UAE
,
Aly Khalil
3   Imperial College London Diabetes Center, Abu Dhabi, UAE
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Objective: We sought to scope the practices in managing thyroid nodules in the Middle East and Africa (MEA). Materials and Methods: Survey of a convenience sample of physicians concerned with the management of thyroid disease. Results: Two hundred and twelve responses are included. Fine needle aspiration (FNA) is performed chiefly using ultrasound guidance (74.9%), generally by radiologists (47.1%). Respondents have a lower threshold for FNA than recommended. Management depends on the FNA cytology, with the follicular lesion of undetermined significance/atypia of undetermined significance resulting in repeat FNA for cytology (40.7%), immediate referral for thyroid surgery (32.9%), or molecular testing (13.2%). Follicular neoplasms are referred for lobectomy or total thyroidectomy by 81.6% of respondents. Nodules suspicious for malignancy are referred for thyroid surgery by 76.6% and for molecular testing by 20.1%. Respondents are less likely to perform FNA in an octogenarian than a younger patient with a comparable nodule. For a multinodular goiter, 29.9%, 25.9%, or 17.8% of respondents would, respectively, sample the largest 2–3 nodules, single largest nodule, or all nodules >1 cm in size. During pregnancy, respondents would perform FNA with nodular growth (27.1%) in the absence of nodular growth (25.6%), but more respondents (35.2%) would defer FNA until after pregnancy. Conclusions: The physicians' survey revealed a practice pattern in managing thyroid nodules in the MEA region, including both agreements and deviations from current guidelines. Focused quality assurance exercises, education, and research are needed.

Keywords

Fine needle aspiration - guidelines - management - therapy - thyroid cancer - thyroid nodule - thyroid surgery - ultrasound-guided biopsy

Financial support and sponsorship

Nil.




Publication History

Received: 23 July 2021

Accepted: 29 August 2021

Article published online:
14 July 2022

© 2021. Gulf Association of Endocrinology and Diabetes (GAED). All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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