2023 European Thyroid Association Clinical Practice Guidelines - Thyroid Nodule Management

Sep 24, 2026

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With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. When cancer is diagnosed, many are small, intrathyroidal, and indolent tumors that can be managed conservatively. The document provides an evidence-based clinical practice guide for the initial workup and subsequent management of adults with thyroid nodules, emphasizing cost-effective, risk-adapted approaches and incorporating patient preferences, while not covering thyroid malignancy management.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Introduction

Definition and prevalence of thyroid nodules

Cancer risk and clinical rationale

Guideline scope and principles

Patient-centered, risk-adapted management

Exclusions: thyroid malignancy coverage

C Durante, L Hegedüs et al. 12:5 e230067 GUIDELINES 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management Cosimo Durante1,*, Laszlo Hegedüs2,*, Agnieszka Czarniecka3, Ralf Paschke4, Gilles Russ5, Fernando Schmitt6, Paula Soares7, Tamas Solymosi8 and Enrico Papini9 1Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy 2Department of Endocrinology, Odense University Hospital, Odense, Denmark 3M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland 4Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 5Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Sorbonne University GRC N°16, Paris, France 6Faculty of Medicine of University of Porto, CINTESIS@RISE and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal 7Institute of Investigation and Innovation in Health (I3S), Faculty of Medicine of the University of Porto, Porto, Portugal 8Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary 9Department of Endocrine and Metabolic Diseases, Regina Apostolorum Hospital, Albano, Rome, Italy Correspondence should be addressed to C Durante: [cosimo.durante@uniroma1.it](cosimo.durante@uniroma1.it) *(C Durante and L Hegedüs contributed equally to this work) | Abstract | | | | --- | --- | --- | | With the widespread use of sensitive imaging techniques, which include neck | | Key Words | | visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. In the case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. There is a pronounced need for more cost-effective, riskadapted approaches to the management of this highly prevalent condition, taking the wishes of the patient into consideration. Thus, the present guidelines aim at providing a clinical practice guide for the initial workup and the subsequent management of adult individuals harboring thyroid nodules. Importantly, these guidelines are not intended | f
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f | thyroid nodule follow-up ultrasound
fine-needle aspiration surgery
minimally invasive treatment molecular biology | | to cover the management of thyroid malignancy. The manuscript and the specific | f | treatment | | recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panelists and updating aspects of a number of previous European Thyroid Association guidelines. | f | management | Introduction A thyroid nodule is a discrete lesion within the thyroid gland that is ultrasonographically distinct from the surrounding thyroid parenchyma. With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid [https://etj.bioscientifica.com](https://etj.bioscientifica.com) © 2023 the author(s) [https://doi.org/10.1530/ETJ-23-0067](https://doi.org/10.1530/ETJ-23-0067) Published by Bioscientifica Ltd. nodules emerge and demand attention. Up to 60% of adults in the general population harbor one or more thyroid nodules (1) . The likelihood of malignancy is an overriding concern, but the actual prevalence of cancer in unselected thyroid nodule populations generally ranges This work is licensed under a Creative Commons Attribution 4.0 International License. C Durante, L Hegedüs et al. 12:5 e230067 from 1 to 5%, with variation related to selection criteria and the population under evaluation, for example, whether papillary micro-carcinomas are included or not (2) . Thus, most lesions are benign, asymptomatic, and do not warrant treatment. In the case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms (up to 53.6%, as shown in one con

FAQs

What is the main purpose of these European Thyroid Association guidelines?

To provide a clinical practice guide for the initial workup and subsequent management of adults with thyroid nodules, using cost-effective and risk-adapted strategies that consider patient preferences.

Do the guidelines intend to cover thyroid malignancy management?

No. The document explicitly states that it is not intended to cover management of thyroid malignancy.

Why is a more conservative approach often emphasized?

Because many nodules are benign and many cancers are indolent, and excessive surgery referrals can worsen cost and risk-benefit balance, increasing morbidity without reducing thyroid cancer mortality meaningfully.

Sep 24, 2026

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