African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings.

Mark Zafereo,Mpessa E Maurice,Rajab M Mugabo,Lisa A Orloff,Mesele Bogale,Merry Sebelik,Adekunle Daniel,Innocent Kundiona,Arnaud Itiere,Jeffrey Otiti,Joyce Aswani,Victor Mashamba,Chege Macharia,Anna Konney,Gregory W Randolph,Patrick Noah,Tobias Todsen,Justin Yu,Khaled Twier,Melesse G Biadgelign,Kenneth Baidoo,Michael G Moore,Johannes J Fagan,Lydia Cairncross,Mary Omutsani,P A Onakoya ,Wayne M Koch ,Garba Mainasara Mohammed ,Fatogoma Issa Koné ,Susan R Cordes ,Evelyne Siga Diom

doi:10.1002/hed.26094

Abstract

International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.

Highlights

Thyroid nodules are common and are estimated to occur in at least 33% of the population.[1]
Total thyroidectomy and central compartment dissection are recommended for Medullary thyroid cancer (MTC) management by the National Comprehensive Cancer Network (NCCN) and American Thyroid Association (ATA) guidelines,[16,37] but this is predicated on availability of calcium and thyroid hormone monitoring and replacement after surgery
Standard evaluation of thyroid nodules is predicated on the availability of U/S, serum thyroid stimulating hormone (TSH), thyroid scans, and/or fine needle aspiration cytology (FNAC)

Summary

| INTRODUCTION

Thyroid nodules are common and are estimated to occur in at least 33% of the population.[1]. Are presented diagnostic and treatment guidelines for management of thyroid nodules and thyroid cancer in low resource settings. The task team used the ADAPTE process, a validated systematic approach to amending evidence-based clinical practice guidelines (Figure 1), to modify diagnostic and treatment protocols developed for resource-rich environments to account for the constraints of low resource settings.[18] Each recommendation that was developed was categorized based on the level of evidence and consensus, similar to system utilized by the NCCN16: Category 1: high level evidence and uniform consensus of the authors

| METHODS

Findings

| CONCLUSIONS