Treatment of Thyroid Tumor Hiroshi Takami Editor-in-Chief Yasuhiro Ito Hitoshi Noguchi ● Akira Yoshida Takahiro Okamoto ● Editors Treatment of Thyroid Tumor Japanese Clinical Guidelines Editor-in-Chief Hiroshi Takami Ito Hospital 4-3-6 Jinguumae Shibuya-ku, Tokyo, Japan Editors Yasuhiro Ito Hitoshi Noguchi Department of Surgery Noguchi Thyroid Clinic and Hospital Kuma Hospital Foundation 8-2-35 Shimoyamate-dori 6-33 Noguchinaka-machi Chuo-ku, Kobe, Japan Beppu, Japan Akira Yoshida Takahiro Okamoto Department of Breast and Endocrine Department of Endocrine Surgery Surgery, Kanagawa Cancer Center Tokyo Women’s Medical University 1-1-2 Nakao, Asahi-ku 8-1 Kawada-cho, Shinjuku-ku Yokohama, Japan Tokyo, Japan This English translation is based on the Japanese original KOJYOSEN SHUYO SHINRYO GUIDELINE 2010 © Japan Association of Endocrine Surgeons, Japanese Society of Thyroid Surgery 2010 Originally published in Japan in 2010 and all rights reserved by KANEHARA & CO., LTD. ISBN 978-4-431-54048-9 ISBN 978-4-431-54049-6 (eBook) DOI 10.1007/978-4-431-54049-6 Springer Tokyo Heidelberg New York Dordrecht London Library of Congress Control Number: 2012942082 © Springer Japan 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. 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The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Creating clinical guidelines is a modern trend. It is clearly bene fi cial to collect published studies pertaining to a given theme, evaluate their credibility, and then present recommended treatment options in the form of evidence-based guidelines. Thus, a Japanese “Clinical Guideline for the Treatment of Thyroid Tumor” was desired by many clinicians. On the other hand, there were counter-arguments and lively debates on the wisdom of creating such a guideline in light of Japan’s restric- tions on the use of radioisotopes and the fact that this is a relatively common disease with wide discrepancies in preferred treatment, even among specialists. Eventually, however, the consensus was in favor of creating an evidence-based Japanese guideline, and a joint effort was made by the Japanese Society of Endocrine Surgery and the Japanese Society of Thyroid Surgery. The editing committee was chaired by Dr. Akira Yoshida and co-chaired by Prof. Takahiro Okamoto. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare served as committee advisor. The four of us met on a summer evening 2 years ago and had an intense discussion, after which a committee of 31 members was cho- sen and, with their concerted efforts and diligence, a guideline was completed over a span of 2 years. I give my sincere thanks to all the committee members, as well as to the Japan Medical Library Association, for their comprehensive search for documents. Though guidelines can be classi fi ed into evidence-based and consensus-based guidelines, this edition is a blend of the two. An evidence-based guideline can be more accurate and exhaustive, but where evidence was absent or insuf fi cient, the consensus of the committee was adopted. It would be my greatest pleasure if this guideline were to be utilized by numerous clinicians to improve the quality of care and treatment outcome. It is also necessary to receive feedback from the fi eld and re fl ect this in subsequent editions. Periodic v vi Foreword revisions will be necessary. Abridged handbooks, online editions, and foreign language information exchange must follow. Lastly, I would like to thank Ms. Hitomi Sasaki of Kanehara Publishing for her devoted assistance. October 2010 Hiroshi Takami President and Director of the Japan Association of Endocrine Surgeons President and Director of the Japanese Society of Thyroid Surgery Preface There are several thyroid tumor treatment guidelines in the West that have estab- lished positions in clinical practice and gone through several editions. However, in Japan, where radioisotope facilities are of limited availability, treatment plans for differentiated thyroid cancer differ from those of foreign countries, and overseas clinical guidelines cannot be adopted without changes. Also, although thyroid tumor is a common disease in endocrine practice, its management can differ even among specialists. For these reasons, the need to develop an original guideline for Japan became widely recognized. The environment surrounding thyroid surgery was also evolving with the establishment of independent accreditation for endocrine and thy- roid surgeons, creating an urgent need for a guideline to complement the certifi cation apparatus. Under these circumstances, an editing committee for the “Clinical Guideline for the Treatment of Thyroid Tumor” was established in October 2008, and it began as a working group. The objective of this group was to create an evi- dence-based “Japanese” guideline and make it public. The editing committee was composed primarily of surgeons and otorhinolaryngologists of the Japanese Society of Endocrine Surgery and the Japanese Society of Thyroid Surgery but also included a broad spectrum of specialists in nuclear medicine, pathology, and nonsurgical med- icine in the fi eld. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare joined us as an advisor and provided a great deal of valuable input. In the year and a half after the committee was organized, the members met seven times to prepare a draft. The timeline is outlined below. 1st Editorial Meeting. October 15, 2008. The general structure was discussed and each team started proposing clinical questions. 2nd Editorial Meeting. January 24, 2009. Clinical questions and columns (important issues that were diffi cult to pose as clinical questions) were chosen. A search of documents pertaining to the clinical questions was commissioned to the Japan Medical Library Association. The resulting documents were distributed to each team. Each team evaluated the documents and composed a structured abstract. vii viii Preface 3rd Editorial Meeting, June 27, 2009. Progress in the structured abstracts was reported by each team. Various issues in the creation of a guideline were dis- cussed. A summary and commentary for the clinical questions were created based on the structured abstracts. 4th Editorial Meeting, September 26, 2009. Evaluation of the recommendations and commentary (about half of the total). Discussion of issues in need of consensus. 5th Editorial Meeting, December 12, 2009. Evaluation of the recommendations and commentary presented after the 4th meeting. More discussion of issues in need of consensus. 6th Editorial Meeting, February 13, 2010. Recommendation ratings to be divided into six grades. Evaluation of the recommendation ratings of each clinical ques- tion. Discussion of diagnostic and treatment algorithms. 7th Editorial Meeting, April 11, 2010. Evaluation of remaining clinical ques- tions. Approval of commentary. Approval of diagnostic and treatment algorithms. Draft completed. Where evidence was insuffi cient, a consensus of the committee was used and an effort was made to make the guideline as complete and comprehensive as possible. Still, there are sections where the consensus was not fully accepted among the mem- bers and further revisions will be required in the future. That the fi rst edition guideline was completed in such a short period owes much to the selfl ess devotion of the committee members who strongly recognized the need for a guideline. We offer our sincere gratitude to the committee members. Editorial Committee of the Clinical Guideline for the Treatment of Thyroid Tumor Yokohama, Japan A kira Yoshida Tokyo, Japan Takahiro Okamoto October 2010 Preface to the English Version This is the English version of the 1st edition of “Guidelines for Management of Thyroid Tumor” established by the Japanese Society of Thyroid Surgery and the Japanese Society of Endocrine Surgeons. There are some leading guidelines for thyroid tumor in Western countries. In Japan, however, the circumstances surround- ing the management and treatment of thyroid tumor differ signifi cantly from those of Western countries because the use of radioactive iodine (RAI) is limited by legal restrictions. This causes differences in therapeutic strategies for thyroid tumor, par- ticularly for well-differentiated thyroid carcinoma, between Western countries and Japan. However, it is also notable that treatment results for thyroid carcinoma in Japan have generally been excellent in spite of such conditions. In recent years, therapeutic experience and outcome data of thyroid tumor in Japan have been accumulated and it is time not only to establish independent guide- lines but also to transmit them to the rest of the world by publishing an English version. As indicated above, treatment strategies for thyroid tumor in Japan differ substantially from those in Western guidelines, and they defi nitely have their own advantages and disadvantages. We are willing to suggest our management and treat- ment of thyroid tumor as alternatives for conventional approaches by introducing them in the guidelines. Also, we think that any disadvantages can be offset by par- tially assimilating the advantages of Western guidelines over time. Ultimately, we hope that the strategies for the management and treatment of thyroid tumor in Western countries and Japan will fi nd an optimal compromise, leading to the best possible treatment for patients all over the world in the not-so-distant future. Kobe, Japan Yasuhiro Ito Beppu, Japan H itoshi Noguchi November 2010 ix