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Arbortext Advanced Print Publisher 9.0.114/W
2016-02-02T18:25:47-08:00
2016-01-07T10:42:10+05:30
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[(Epidemiologic)-474.6(studies)-469.5(have)-467.5(shown)-472.7(the)-471.1(prevalence)-471.9(of)]TJ
-1.8661 -1.1116 TD
[(palpable)-289(thyroid)-284.4(nodules)-291(to)-284.5(be)-285.6(approximately)-290.1(5%)-285.5(in)-284.5(women)]TJ
0 -1.1174 TD
[(and)-298.2(1%)-297(in)-296.1(men)-293.7(living)-295(in)-296.1(iodine-sufc)-9.6(ient)-293.8(parts)-300.3(of)-295.9(the)-292.6(world)]TJ
0 -1.1116 TD
[(\(1,2\).)-253.1(In)-255.6(contrast,)-256.5(high-resolution)-254.1(ultrasound)-254.1(\(US\))-258.5(can)-253.3(detect)]TJ
T*
[(thyroid)-319(nodules)-325.6(in)-319.1(19%68%)-320.9(of)-318.9(randomly)-322.3(selected)-324.6(individ-)]TJ
0 -1.1174 TD
[(uals,)-233.6(with)-235.9(higher)-232.5(frequencies)-241.3(in)-232.7(women)-233.4(and)-234.8(the)-229.2(elderly)-234.9(\(3,4\).)]TJ
0 -1.1116 TD
[(The)-184.2(clinical)-191.4(importance)-188.8(of)-180.7(thyroid)-186.5(nodules)-187.4(rests)-184.9(with)-184.1(the)-183.1(need)]TJ
T*
[(to)-284.6(exclude)-287.8(th)20.7(yr)20.9(oi)20.7(d)-271.8(c)0(a)18.5(n)0(c)13.9(e)0(r)19.7(,)-268.4(wh)14.2(ic)19.6(h)-271.8(o)0(c)19.7(c)0(u)19.7(r)0(s)-266.9(i)0(n)-261.5(7)0(%)19.8()0(1)20.8(5)0(%)-262.4(o)0(f)-261.4(c)0(a)18.5(s)0(e)14.1(s)]TJ
0 -1.1174 TD
[(de)19.7(pe)19.7(nd)20.8(in)15(g)-490.7(o)0(n)-486(a)0(g)19.7(e)0(,)-483.7(s)0(e)14.1(x)0(,)-482.6(r)0(a)19.7(d)0(i)20.7(a)0(t)19.5(i)0(o)15(n)-490.7(ex)19.7(po)15.1(su)21(re)-487.1(hi)20.7(st)20.9(or)20.9(y,)-488.3(fa)19.7(mi)19.5(ly)]TJ
0 -1.1116 TD
[(hi)20.7(st)15.1(or)20.9(y,)-298.3(an)19.7(d)-312.1(o)0(t)20.7(h)0(e)19.7(r)-312.1(fa)14(ct)19.5(or)20.9(s)-311.9(\()0(5)20.9(,)0(6)18.5(\))0(.)-298.2(D)0(i)19.8(f)0(f)15.1(e)0(r)19.7(e)0(n)19.7(t)0(i)20.6(a)0(t)19.5(e)0(d)-302.9(t)0(h)20.7(y)0(r)15.1(o)0(i)20.7(d)-312.1(ca)18.5(nc)19.7(er)]TJ
T*
[(\(D)20(TC)18.6(\),)-332.8(wh)20(ic)19.6(h)-340.9(i)0(n)20.7(c)0(l)19.5(u)0(d)20.8(e)0(s)-331.5(p)0(a)19.7(p)0(i)20.7(l)0(l)14.8(a)0(r)19.7(y)-340.9(an)19.7(d)-335.2(f)0(o)15.1(l)0(l)20.6(i)0(c)19.6(u)0(l)20.7(a)0(r)-331.6(c)0(a)18.5(n)0(c)19.7(e)0(r)19.7(,)-343.2(co)19.7(m-)]TJ
0 -1.1174 TD
[(pr)20.9(is)15.1(es)-296.9(th)20.7(e)-307.5(v)0(a)19.7(s)0(t)-295.9(m)0(a)18.4(j)0(o)20.7(r)0(i)15(t)0(y)-296.1(\()]TJ
/F6 1 Tf
9.9643 0 TD
(>)Tj
/F5 1 Tf
.5414 0 TD
[(90)20.8(%\))-297(of)-295.9(al)13.8(l)-306.5(t)0(h)20.7(y)0(r)20.9(o)0(i)20.7(d)-306.4(ca)18.5(nc)19.7(er)19.7(s)-311.9(\()0(7)20.9(\))0(.)-298.2(I)0(n)]TJ
-10.5057 -1.1116 TD
[(th)20.7(e)-261.4(U)0(n)20(i)0(t)20.6(e)0(d)-245.3(S)0(t)15.1(a)0(t)19.5(e)0(s)19.9(,)-256.9(ap)19.7(pr)20.9(ox)20.8(im)19.5(at)19.5(el)13.8(y)-254.5(6)0(3)20.8(,)0(0)18.5(0)0(0)-244.1(n)0(e)19.7(w)-261.2(ca)18.5(se)19.9(s)-260.1(o)0(f)-244.1(t)0(h)20.7(y)0(r)15.1(o)0(i)20.7(d)]TJ
T*
[(ca)18.5(nc)19.7(er)-291.3(we)18.8(re)-285.6(pr)20.9(ed)19.7(ic)13.8(te)19.5(d)-294.8(t)0(o)-290.3(b)0(e)-285.6(d)0(i)20.7(a)0(g)19.7(n)0(o)20.8(s)0(e)14.1(d)-294.8(in)-284.6(20)20.8(14)-290.2(\(8)20.9(\))-300.6(c)0(o)19.7(m)0(p)19.6(a)0(r)19.7(e)0(d)]TJ
T*
[(wi)19.8(th)-480.4(37)20.8(,2)18.5(00)-480.3(in)-480.4(20)20.8(09)-480.3(wh)20(en)-475.7(th)15(e)-486.1(l)0(a)19.6(s)0(t)-480.2(A)0(T)18.8(A)-491.5(gu)20.8(id)20.7(el)13.8(in)20.7(es)-481.2(we)18.8(re)]TJ
0 -1.1174 TD
[(pu)20.8(bl)20.7(is)15.1(he)19.7(d.)-177.3(Th)19.6(e)-192.3(y)0(e)19.7(a)0(r)19.7(l)0(y)-180.9(i)0(n)20.7(c)0(i)13.8(d)0(e)19.7(n)0(c)19.7(e)-192.3(ha)19.7(s)-191(n)0(e)19.7(a)0(r)19.7(l)0(y)-180.9(t)0(r)20.7(i)0(p)20.7(l)0(e)19.5(d)-191.2(fr)20.9(om)-182(4.)18.5(9)-191.2(p)0(e)19.7(r)]TJ
0 -1.1116 TD
[(10)20.8(0,)18.5(00)20.8(0)-289.1(i)0(n)-278.8(1)0(9)20.8(7)0(5)-284.4(t)0(o)-278.8(1)0(4)20.8(.)0(3)-281(p)0(e)19.7(r)-289(10)20.8(0,)18.5(00)20.8(0)-289.1(i)0(n)-278.8(2)0(0)20.8(0)0(9)-278.7(\()0(9)15.1(\))0(.)-275.2(A)0(l)19.8(m)0(o)19.6(s)0(t)-284.4(t)0(h)20.7(e)]TJ
T*
[(en)19.7(ti)20.6(re)-354.7(ch)19.7(an)19.7(ge)-348.9(ha)19.7(s)-363.8(b)0(e)19.7(e)0(n)-348.9(a)0(t)19.5(t)0(r)15(i)0(b)20.7(u)0(t)20.7(e)0(d)-348.9(t)0(o)-353.7(a)0(n)-348.9(i)0(n)20.7(c)0(r)19.7(e)0(a)18.5(s)0(e)-354.5(i)0(n)-347.9(t)0(h)20.7(e)-359.4(in)15(ci)19.5(-)]TJ
0 -1.1174 TD
[(de)19.7(nc)19.7(e)-180.8(o)0(f)-169.2(p)0(a)19.7(p)0(i)20.7(l)0(l)20.6(a)0(r)19.7(y)-179.6(th)20.7(yr)20.9(oi)20.7(d)-179.6(c)0(a)18.5(n)0(c)19.7(e)0(r)-170.4(\()0(P)21(T)0(C)18.6(\))0(.)-171.5(M)0(o)19.9(r)0(e)19.7(o)0(v)20.8(e)0(r)19.7(,)-176.2(25)20.8(%)-180.7(o)0(f)-169.2(t)0(h)20.7(e)]TJ
0 -1.1116 TD
[(ne)19.7(w)-480(t)0(h)20.7(y)0(r)20.9(o)0(i)14.9(d)-473.4(ca)12.8(nc)19.7(er)19.7(s)-479(d)0(i)20.7(a)0(g)19.7(n)0(o)20.8(s)0(e)19.9(d)-479.2(in)-468.9(19)20.8(88)15.1(1)20.8(98)20.8(9)-479.2(w)0(e)18.8(r)0(e)]TJ
/F6 1 Tf
21.8754 0 TD
()Tj
/F5 1 Tf
.5414 0 TD
.1566 Tc
[(1c)156.6(m)]TJ
-22.4168 -1.1116 TD
0 Tc
[(co)19.7(mp)19.6(ar)19.7(ed)-337.4(wi)19.8(th)-336.4(39)20.8(%)-347.7(o)0(f)-336.2(t)0(h)20.7(e)-347.8(ne)19.7(w)-347.5(t)0(h)20.7(y)0(r)20.9(o)0(i)20.7(d)-346.7(ca)18.5(nc)19.7(er)-337.4(di)20.7(ag)19.7(no)15.1(se)19.9(s)-346.5(i)0(n)]TJ
0 -1.1174 TD
[(20)20.8(08)20.8(2)15.1(00)20.8(9)-254.5(\()0(9)20.9(\))0(.)-246.4(T)0(h)19.6(i)0(s)-244(t)0(u)20.7(m)0(o)19.6(r)-254.5(sh)21(if)15(t)-254.7(m)0(a)18.4(y)-254.5(be)-245.3(du)20.8(e)-255.7(t)0(o)-244.2(t)0(h)20.7(e)-255.7(in)20.7(cr)19.7(ea)18.5(si)15.1(ng)]TJ
0 -1.1116 TD
[(us)21(e)-273(o)0(f)-255.6(n)0(e)13.9(c)0(k)-256.8(u)0(l)20.7(t)0(r)15(a)0(s)19.9(o)0(n)20.8(o)0(g)20.8(r)0(a)19.7(p)0(h)20.8(y)-271.8(or)-255.6(ot)15(he)19.7(r)-266(i)0(m)19.5(a)0(g)19.7(i)0(n)15(g)-266(an)19.7(d)-271.8(e)0(a)18.5(r)0(l)20.7(y)-271.8(di)20.7(ag)19.7(-)]TJ
T*
[(no)20.8(si)20.9(s)-340.7(a)0(n)19.7(d)-340.9(tr)20.7(ea)18.5(tm)19.5(en)13.9(t)-335.3(\()0(1)15.1(0)0(\))20.9(,)-337.5(tr)20.7(en)19.7(ds)-330.3(th)15(at)-326(ar)19.7(e)-342.1(c)0(h)19.7(a)0(n)19.7(g)0(i)14.9(n)0(g)-324.7(t)0(h)15(e)-336.3(in)20.7(it)14.8(ia)19.6(l)]TJ
0 -1.1174 TD
[(tr)20.7(ea)18.5(tm)19.5(en)19.7(t)-185.5(a)0(n)19.7(d)-185.4(fo)20.9(ll)20.6(ow)14.2(-u)20.9(p)-185.4(f)0(o)20.9(r)-185.4(m)15(a)0(n)13.9(y)-179.6(pa)19.7(ti)14.8(en)19.7(ts)-174.9(wi)19.8(th)-175.1(th)20.7(yr)20.9(oi)20.7(d)-185.4(c)0(a)18.5(n)0(c)19.7(e)0(r)19.7(.)]TJ
0 -1.1116 TD
[(A)-433.9(r)0(e)19.7(c)0(e)18.5(n)0(t)-428.5(p)0(o)20.8(p)0(u)20.8(l)0(a)19.6(t)0(i)20.6(o)0(n)20.8(-)0(b)15.1(a)0(s)19.9(e)0(d)-423.8(s)0(t)20.9(u)0(d)20.8(y)-433.1(fr)15.1(om)-423.9(Ol)19.8(ms)19.8(te)19.6(d)-433.1(C)0(o)19.8(u)0(n)20.8(t)0(y)-428.5(r)0(e)19.7(-)]TJ
T*
[(po)20.8(rt)20.7(ed)-262.5(th)20.7(e)-267.2(d)0(o)20.8(u)0(b)15.1(l)0(i)20.6(n)0(g)-255.6(o)0(f)-261.4(t)0(h)20.7(y)0(r)20.9(o)0(i)20.7(d)-266(ca)18.5(nc)13.9(er)-256.8(in)20.7(ci)19.5(de)19.7(nc)19.7(e)-273(f)0(r)20.9(o)0(m)-256.8(2)0(0)20.8(0)0(0)-261.4(t)0(o)]TJ
T*
[(20)20.8(12)-295.9(co)19.7(mp)19.6(ar)19.7(ed)-297.1(to)-290.3(th)20.7(e)-307.5(p)0(r)20.9(i)0(o)20.7(r)-306.3(de)19.7(ca)18.5(de)-297.1(as)-291.1(en)19.7(ti)14.8(re)19.7(ly)-290.3(at)19.5(tr)15(ib)20.7(ut)20.7(ab)19.7(le)-297.2(to)]TJ
0 -1.1174 TD
[(cl)19.5(in)20.7(ic)19.5(al)13.8(ly)-319.1(oc)19.7(cu)19.7(lt)-319.2(ca)18.5(nc)19.7(er)19.7(s)-329.2(d)0(e)19.7(t)0(e)13.8(c)0(t)19.5(e)0(d)-320.1(i)0(n)20.7(c)0(i)19.5(d)0(e)19.7(n)0(t)20.7(a)0(l)19.5(l)0(y)-319.1(o)0(n)-319(i)0(m)19.5(a)0(g)19.7(i)0(n)15(g)-329.4(or)]TJ
0 -1.1116 TD
[(pa)19.7(th)20.7(ol)20.7(og)15.1(y)-398.5(\()0(1)15.1(1)0(\))20.9(.)-400.8(By)-394.9(20)20.8(19)20.8(,)-406.6(o)0(n)20.8(e)-405.4(st)20.9(ud)20.8(y)-404.3(p)0(r)20.9(e)0(d)19.7(i)0(c)13.8(t)0(s)-393.8(t)0(h)20.7(a)0(t)-395.2(P)0(T)19.8(C)-405.3(wi)19.8(ll)]TJ
T*
[(be)19.7(co)19.7(me)-258(th)15(e)-267.2(t)0(h)20.7(i)0(r)20.7(d)-271.8(m)15(o)0(s)15.3(t)-266.2(co)19.7(mm)18.4(on)-255.6(ca)18.5(nc)19.7(er)-262.5(in)-255.8(wo)20(me)18.4(n)-271.8(a)0(t)-256.9(a)-267.2(co)19.7(st)-261.3(of)]TJ
0 -1.1174 TD
[($1)20.8(9)20.8(21)-192.3(bi)20.7(ll)20.6(io)15(n)-196.9(i)0(n)-192.4(t)0(h)20.7(e)-203.8(Un)20(it)20.6(ed)-193.4(St)20.9(at)19.5(es)-193.2(\(1)20.9(2\))20.9(.)-199.3(O)0(p)14.2(t)0(i)20.6(m)0(i)19.5(z)0(a)18.5(t)0(i)20.6(o)0(n)-192.3(o)0(f)-186.5(l)0(o)15(n)0(g)20.8(-)]TJ
0 -1.1116 TD
[(te)19.5(rm)-222.3(he)19.7(al)19.5(th)-221.2(ou)20.8(tc)19.5(om)19.6(es)-222(an)19.7(d)-231.5(e)0(d)19.7(u)0(c)19.7(a)0(t)19.5(i)0(o)20.7(n)-231.5(ab)19.7(ou)20.8(t)-231.6(p)0(o)20.8(t)0(e)19.6(n)0(t)20.7(i)0(a)19.6(l)-231.6(pr)20.9(og)20.8(no)20.8(si)15.1(s)]TJ
T*
[(fo)20.9(r)-266(i)0(n)20.7(d)0(i)20.7(v)0(i)20.7(d)0(u)20.8(a)0(l)19.5(s)-265.8(wi)19.8(th)-250(th)15(yr)20.9(oi)20.7(d)-260.3(n)0(e)19.7(o)0(p)15.1(l)0(a)19.6(s)0(m)19.8(s)-260.1(is)-255.6(cr)19.7(it)20.6(ic)19.6(al)19.5(ly)-255.8(im)19.5(po)20.8(rt)20.7(an)19.7(t.)]TJ
1.0137 -1.1174 TD
[(In)-353.5(1996,)-359.2(the)-355.9(American)-365.8(Thyroid)-354.6(Association)-360.9(\(ATA\))-359.7(pub-)]TJ
-1.0137 -1.1116 TD
[(lished)-272.8(treatment)-274.2(guidelines)-272.7(for)-268.2(patients)-270.5(with)-270.5(thyroid)-272.9(nodules)]TJ
T*
[(and)-367.3(DTC)-363.5(\(13\).)-364.9(Over)-363.5(the)-367.5(last)-362.7(1520)-362.6(years,)-368.1(there)-365(have)-363.8(been)]TJ
T*
[(many)-294.8(advances)-295.5(in)-290.3(the)-292.6(diagnosis)-293.2(and)-292.4(therapy)-298.1(of)-290.2(both)-292.5(thyroid)]TJ
0 -1.1174 TD
[(nodules)-400.5(and)-401.9(DTC,)-407.3(but)-400.9(clinical)-404.5(controversy)-406(exists)-399.3(in)-399.7(many)]TJ
0 -1.1116 TD
[(areas.)-329(A)-324.5(long)-321.3(history)-330.3(of)-324.7(insufcient)-325.5(peer-reviewed)-332.1(research)]TJ
T*
[(funding)-290(for)-291.2(high-quality)-291.3(clinical)-295(trials)-290.2(in)-290.3(the)-286.8(eld)-293.5(of)-290.2(thyroid)]TJ
0 -1.1174 TD
[(neoplasia)-226.6(may)-218.8(be)-222.2(an)-216.5(impor)-6.8(tant)-218.9(contributing)-222.2(factor)-222.1(to)-221.2(existing)]TJ
0 -1.1116 TD
[(clinical)-295(uncertainties)-290(\(12\).)-290(Methodologic)-293.3(limitations)-291.6(or)-284.4(con-)]TJ
T*
[(icting)-377.7(ndings)-381.9(of)-376.5(older)-381.1(studies)-377.4(present)-378.6(a)-382.4(signicant)-376.2(chal-)]TJ
0 -1.1174 TD
[(lenge)-601.2(to)-601.3(modern-day)-602(medical)-605.9(decision-making)-608.9(in)-595.6(many)]TJ
0 -1.1116 TD
[(aspects)-235.6(of)-232.6(thyroid)-232.6(neoplasia.)-241.5(Although)-234.6(they)-230.3(are)-236(not)-233.8(a)-232.6(specic)]TJ
T*
[(fo)20.9(cu)19.7(s)-185.2(o)0(f)-180.7(t)0(h)20.7(e)15(se)-181.7(gu)20.8(id)26.5(el)19.5(in)20.7(es)19.9(,)-187.7(w)0(e)-177(r)0(e)19.7(c)0(o)19.7(g)0(n)20.8(i)0(z)19.6(e)-186.6(th)20.7(at)-176.3(fe)19.7(as)19.9(ib)20.7(il)20.6(i)16.1(t)0(y)-180.9(a)0(n)19.7(d)-185.4(co)19.7(st)]TJ
0 -1.1174 TD
[(co)19.7(ns)21(id)20.7(er)19.7(a)15(t)0(i)20.6(o)0(n)20.8(s)-375.3(of)-365(v)16.2(a)0(r)19.7(i)0(o)20.7(u)0(s)-364.9(d)0(i)20.7(a)0(g)25.4(n)0(o)20.8(s)0(t)20.9(i)0(c)-366.3(a)0(n)19.7(d)-369.7(th)20.7(er)19.7(ap)19.7(eu)19.7(ti)26.3(c)-376.6(o)0(p)20.8(t)0(i)20.6(o)0(n)20.8(s)]TJ
25.504 55.6733 TD
[(al)19.5(so)-445.5(pr)20.9(e)15(s)0(e)19.9(n)0(t)-445.8(i)0(m)25.2(p)0(o)20.8(r)0(t)20.7(a)0(n)19.7(t)-450.5(cl)19.6(in)20.7(ic)19.5(al)-441.2(ch)19.7(al)19.5(le)25.3(ng)20.8(es)-446.7(in)-440.1(ma)18.4(n)16.2(y)-456.1(cl)19.5(in)26.5(ic)19.6(al)]TJ
0 -1.1174 TD
[(pr)20.9(ac)18.5(ti)20.6(ce)-258(se)19.9(tt)20.6(in)20.7(gs)21(.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 313.0582 566.192 Tm
[(AIM)-336.8(AND)-337.2(TARGET)-334(AUDIENCE)]TJ
/F5 1 Tf
9.843 0 0 9.843 323.0361 549.751 Tm
[(Our)-349.7(objective)-353.6(in)-347.9(these)-353.4(guidelines)-353.4(is)-347.7(to)-347.9(inform)-347.7(clinicians,)]TJ
-1.0137 -1.1116 TD
[(patients,)-227.9(researchers,)-228.2(and)-223.3(health)-222.3(policy)-221.1(makers)-223(about)-225.7(the)-223.5(best)]TJ
T*
[(available)-360.5(evidence)-359.2(\(and)-351.1(its)-354.7(limitations\),)-353.7(relating)-357.1(to)-353.7(the)-355.9(dia-)]TJ
0 -1.1174 TD
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(a)Tj
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[(ATA)-340.1(THYROID)-334.7(NODULE/DTC)-339.7(GUIDELINES)]TJ
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T*
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T*
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(a)Tj
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[(Knowledge)-335.5(of)-330.2(the)-338.3(diagnostic)]TJ
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[(test)-333.5(result)-335.5(clearly)-339(outweighs)]TJ
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[(risks)-333(and)-332.4(burden)-335.3(of)-336(testing)]TJ
T*
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(Patients:)Tj
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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(4.)Tj
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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[(58)-4931.3([B38])]TJ
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T*
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(R53)Tj
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[(59)-4931.3([B39])]TJ
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T*
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T*
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[(63)-4931.3([B41])]TJ
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(R58)Tj
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[(65)-4931.3([B45])]TJ
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T*
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[(66)-4931.3([C6])-4421.8(Serum)-335.4(Tg)-331.4(measurement)-340.4(and)-332.4(clinical)-340.4(utility)]TJ
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T*
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[(69)-4931.3([C10])-3921.8(Cervical)-335.3(ultrasonography)-20126.2(R65)]TJ
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[(69)-4931.3([C11])-3921.8(Diagnostic)-335.9(whole-body)-334.5(RAI)-338.8(scans)-16361.2(R6667)]TJ
T*
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(18)Tj
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7.3837 0 0 6.5625 233.9716 104.2015 Tm
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13.1756 -1.0135 TD
[(disease)-338.5(long-term)-334.1(surveillance)-339.4(and)-332.4(therapeutic)-338.6(management)]TJ
T*
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(8)Tj
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[(HAUGEN)-334.7(ET)-338.7(AL.)]TJ
ET
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[(74)-4931.3([C18])-3921.8(Nodal)-335.4(size)-340.3(threshold)]TJ
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[(77)-4931.3([C27])-3921.8(Use)-338.8(of)-330.2(lithium)-337(in)]TJ
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[(78)-4931.3([C29])-3921.8(Treatment)-337.6(of)-336(pulmonary)-333.9(metastases)-15776.7(R7778)]TJ
T*
[(78)-4931.3([C30])-3921.8(RAI)-338.8(treatment)-336.6(of)-330.2(bone)-339.1(metastases)-16450.5(R79)]TJ
T*
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[(87)-4931.3([C46])-3921.8(Cytotoxic)-339.8(chemotherapy)-20397.4(R100)]TJ
T*
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T*
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T*
[(91)-4931.3([D8])-4369.8(Novel)-335.4(therapies)-340.8(for)-331.2(systemic)-339.7(RAI-refractory)-336.1(disease)]TJ
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[(91)-4931.3([D9])-4369.8(Survivorship)-334.4(care)]TJ
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(a)Tj
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[(F,)-331.7(gure;)-334.7(R,)-334.3(recommendation;)-333.5(T,)-328(table.)]TJ
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(c)Tj
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(18)Tj
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(FDG-PET,)Tj
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([)Tj
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(18)Tj
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T*
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8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ATA)-340.1(THYROID)-334.7(NODULE/DTC)-339.7(GUIDELINES)]TJ
54.1178 0 TD
(9)Tj
ET
endstream
endobj
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BT
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[([A1])-333.9(THYROID)-334.7(NODULE)-337.5(GUIDELINES)]TJ
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[(A)-242.5(t).1(h)-5.5(y).2(ro)-5.5(id)-241.7(no)-5.5(dul)-5.6(e)-242.8(i).1(s)-241.5(a)-242.8(d)-5.5(i).1(sc)-6.7(ret)-5.6(e)-242.8(les)-5.3(i).1(o)-5.5(n)-241.7(wit)-5.6(h).2(in)-247.4(the)-242.8(t)-5.6(hyr)-5.5(oid)-241.7(g)-5.5(lan)-5.5(d)]TJ
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T*
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T*
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T*
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[(Ge)-6.6(ner)-5.4(a)-.8(ll)-5.5(y,)-284.2(on)-5.4(ly)-281.9(no)-5.4(dul)-5.5(es)]TJ
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(>)Tj
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[(1)-166.8(c)-.9(m)-283.2(s)-5.3(hou)-5.5(ld)-282(be)-288.9(eval)-5.6(ua)-6.7(ted)-5.5(,)-278.6(s)-5.3(i).1(nc)-6.7(e)-283.1(t).1(he)-6.7(y)]TJ
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[(ha)-5.1(ve)-471.6(a)-471.6(g)1.8(re)-5.1(ate)-5.1(r)-470.4(potential)-470.6(to)-464.7(be)-471.6(clinic)-5.1(ally)-470.5(signica)-5.1(nt)-470.6(cancers.)]TJ
T*
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[(Oc)-6.4(cas)-5(io)-5.2(nal)-5.3(l).4(y,)-312.8(t)-5.3(h).5(er)-5.2(e)-311.6(m)-.7(ay)-316.2(be)-311.6(n)-5.2(odu)-5.2(les)]TJ
/F6 1 Tf
14.2495 0 TD
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(<)Tj
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[(1)-167(c)-6.9(m)-312.2(t)-.1(ha)-6.9(t)-311.1(r).1(e)-6.9(qui)-5.8(re)-317.9(fur)-5.7(t)-.1(he)-6.9(r)]TJ
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[(evaluation)-315.1(be)-5.3(cause)-316.3(of)-315.1(clinical)]TJ
11.8823 0 TD
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[(symptoms)-314.5(or)-314.7(associa)-4.9(t)1.9(ed)-314.7(lymph-)]TJ
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[(adenopathy.)-270.6(I)2.5(n)-274(v)2.4(e)-4.5(r)2.5(y)-274(r)2.5(ar)]TJ
9.0255 0 TD
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[(e)-271.4(c)-6.5(as)-5.1(es,)-278.4(s).6(om)-6.5(e)-271.4(n)-5.3(odu)-5.3(les)]TJ
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[(1c)165.9(m)-110.6(l)166.9(a)165.9(c)160.1(k)-103.7(t)161.2(h)167(e)165.9(s)161.5(e)]TJ
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[(s)-5.2(ono)-5.4(gra)-6.6(phi)-5.5(c)-432.8(a)-.8(nd)-431.6(c)-6.6(lin)-5.4(ica)-6.6(l)-431.8(war)-5.4(n).3(in)-5.4(g)-431.6(s).5(ig)-5.4(ns)-431.4(ye)-6.6(t)-431.8(m)-.9(ay)-431.6(no)-5.4(net)-5.5(h).3(e)-6.6(l).2(es)-5.2(s)]TJ
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T*
[(at)-5.4(tem)-6.5(p).4(ts)-270.1(to)-270.3(dia)-6.5(gno)-5.3(se)-265.7(a)-6.5(n).4(d)-264.5(t)-5.4(re)-6.5(at)-264.6(a)-6.5(l).3(l)-264.6(s)-5.1(uch)-270.3(s).6(ma)-6.5(ll)-264.6(t)-5.4(h).4(y)-5.3(r).5(oi)-5.4(d)-264.5(c)-.7(a)-6.5(n).4(ce)-6.5(rs)-264.3(i)-5.4(n)]TJ
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T*
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T*
-.0215 Tc
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0 -1.1174 TD
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[(and)-279.5(can)-279.5(be)-280.6(effective)-4.2(l)2.6(y)-279.5(t)2.6(reated.)]TJ
/F10 1 Tf
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0 Tc
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0 -1.2203 TD
[(in)-300(people)-307.5(with)-298.9(familial)-303.5(follicular)-302.6(cellderived)-302(DTC?)]TJ
/F11 1 Tf
5.9777 0 0 5.9777 61.2283 413.2346 Tm
(&)Tj
/F1 1 Tf
8.9663 0 0 8.9663 71.6598 410.74 Tm
[(RECOMMENDATION)-290.5(1)]TJ
/F5 1 Tf
9.843 0 0 9.843 72.1701 399.7983 Tm
[(Screening)-606.6(people)-602.3(with)-598.8(familial)-600.3(follicular)-607(cellderived)]TJ
0 -1.1116 TD
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0 -1.1174 TD
[(the)-309.9(panel)-313.2(cannot)-314.3(recommend)-315.3(for)-308.5(or)-307.4(against)-315.4(US)-308.2(screening)]TJ
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T*
-.0265 Tc
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/F7 1 Tf
0 -1.6703 TD
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[(\(No)-280.6(recommend)-10.6(ation,)-279.6(Insufcient)-284.2(evidence\))]TJ
/F5 1 Tf
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[(S)5.5(c)-1.6(reen)5.3(in)5.3(g)-426.6(p)5.3(rog)5.3(rams)-420.7(fo)5.3(r)-426.6(p)-.4(ati)5.2(e)-1.6(n)5.3(t)-.5(s)-426.4(a)4.2(t)-426.8(r)5.4(isk)-420.9(o)-.4(f)-420.8(o)-.4(n)5.3(c)-1.6(o)5.3(l)-.5(og)5.3(ical)]TJ
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[(di)5(sease)-341.6(a)4(re)-341.6(u)5.1(s)-.4(uall)5(y)-346.2(a)4(dv)5.1(ocat)]TJ
11.4157 0 TD
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[(ed)-339.9(based)-339.9(o)-.1(n)-339.9(t)-.2(h)5.6(e)-341.1(fol)5.5(lo)5.6(wi)5.5(ng)-339.9(ev)5.6(i-)]TJ
-11.4157 -1.1116 TD
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[(dence:)-231.7(\(a\))-231.6(a)-238.5(clear)-231.6(d)4.5(emon)4.5(str)4.6(a)-2.4(t)4.4(i)-1.3(on)-231.6(t)4.4(h)-1.2(at)-237.5(t)4.4(h)-1.2(e)-232.8(p)-1.2(ati)4.4(e)-2.4(n)4.5(t)-231.7(is)-231.4(in)4.5(deed)-231.6(at)]TJ
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0 -1.1116 TD
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12.9939 0 TD
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[(ge;)-404(\()5.1(c\))-398.1(earl)4.9(y)-403.9(d)5(iagn)5(osi)4.9(s)-403.7(h)5(a)-1.9(s)]TJ
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12.3776 0 TD
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-12.3776 -1.1116 TD
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[(su)5.1(rv)5.1(ival.)]TJ
1.0137 -1.1174 TD
-.0216 Tc
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-1.0137 -1.1116 TD
[(considered)-304.8(at)-304.9(ris)-5.1(k)-304.8(based)-304.8(o).4(n)-304.8(e)-.7(pidemiological)-304.9(evidence)-306(showing)]TJ
T*
[(that)-236(5%10%)-237(of)-241.6(DTCs)-241.5(have)-237.1(a)-237.1(f).3(amilial)-236(o).2(ccurrence.)-238.2(However,)-238.2(in)]TJ
0 -1.1174 TD
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0 -1.1116 TD
-.0214 Tc
[(controversy)-362.3(o).5(n)-356.6(w)-.3(hether)-356.5(two)-356.6(f).6(amily)-356.6(members)-356.4(a)-.6(re)-357.7(sufcient)-356.7(t).4(o)]TJ
T*
-.0217 Tc
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0 -1.1174 TD
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0 -1.1116 TD
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[(when)-385.3(only)-391(t).5(wo)-385.3(rst-degree)-386.4(f).7(amily)-385.3(members)-385.1(a)-.5(re)-392.2(affected,)-387.6(t).5(he)]TJ
T*
-.0219 Tc
[(probability)-276.4(that)-270.8(the)-271.8(d)0(iseas)-5.5(e)-271.8(i)-.1(s)-270.5(s).2(por)-5.7(ad)-5.7(ic)-271.8(is)-270.5(62%.)-273(T)-1.1(his)-276.2(p)0(robability)]TJ
0 -1.1174 TD
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[(decreases)-229.6(when)-224(the)-230.9(number)-229.7(o).6(f)-224(a)-.5(ffected)-229.7(family)-229.7(m)5.2(e)-.5(mbers)-229.5(i).5(s)-229.5(t).5(hree)]TJ
0 -1.1116 TD
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/F9 1 Tf
17.6362 0 TD
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[(et)-276(al.)]TJ
/F5 1 Tf
2.2117 0 TD
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[(\(35\),)-278.5(w)-.5(hich)]TJ
-19.8479 -1.1116 TD
[(was)-558.2(s).5(tatistically)-558.3(adjusted)-558.3(to)-558.3(minimize)-559.5(risk)-558.3(of)-558.3()52.2()-5.4(insufcient)]TJ
T*
[(follow-up)-282(bias,)46.4()-276.2(d).2(emonstrates)-281.8(that)-276.4(even)-282(whe)4.8(n)-282(only)-276.2(t).1(wo)-282(family)]TJ
0 -1.1174 TD
[(members)-281.6(a)-.7(re)-282.9(affected,)-278.4(t).3(he)-282.9(disease)-282.9(d).4(isplays)-281.6(t).3(he)-282.9(features)-281.6(of)-281.8()46.6().5(ge-)]TJ
0 -1.1116 TD
-.0218 Tc
[(netic)-317.8(anticipation)52()-316.6(\().2(occurrence)-312(o).1(f)-316.6(t)0(he)-312(dis)-5.4(e)-1(as)-5.4(e)-312(a)-1(t)-316.8(a)-1(n)-310.9(earlier)-316.6(a)-1(ge)]TJ
T*
[(and)-253.3(w)-.7(ith)-247.5(more)-254.4(aggr)-5.6(essive)-248.7(presentation)-253.3(i)0(n)-247.5(t)0(h)-5.6(e)-248.7(subsequent)-253.4(gener-)]TJ
0 -1.1174 TD
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0 -1.1116 TD
[(good)-230(evidence)-231.2(for)-230(a)-231.2(distinct)-230.2(clinical)-230.2(entity)-230(poss)-5.2(i).2(bly)-230(r).4(epresenting)]TJ
25.504 67.9242 TD
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[(t)-5.3(r).6(ue)-225.2(familial)-224.2(d).5(isease.)-226.4(Appearance)-225.2(of)-224.1(the)-225.2(d).5(iseas)-5(e)-225.2(a)-.6(t)-224.2(a)-.6(n)-224.1(earlier)-224(a)-.6(ge)]TJ
0 -1.1174 TD
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[(has)-183.8(a)-.8(lso)-178.2(b).3(een)-178.2(found)-178.2(by)-178.2(Moses)]TJ
/F9 1 Tf
11.3524 0 TD
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[(et)-183.8(al.)]TJ
/F5 1 Tf
2.0101 0 TD
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[(\()6.2(3)6.1(6)6.1(\))6.2(.)-174.7(M)-.5(or)-15.8(e)-168.9(a)-.8(dv)-15.8(a)9.6(n).4(ced)-183.9(dis)-15.8(e)9.8(ase)]TJ
-13.3625 -1.1116 TD
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T*
-.0153 Tc
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/F9 1 Tf
12.32 0 TD
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[(et)-253(al)-15.6(.)]TJ
/F5 1 Tf
2.1887 0 TD
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[(\()-16(3)10.6(5\).)-255.6(Mor)-16(e)-244(fre)-16(q)9.4(u).2(ent)-259.1(m)-1(ul-)]TJ
-14.5087 -1.1116 TD
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[(t)-15.5(i)10.8(cen)-15.5(t)11(r).7(ici)-15.5(t)10.8(y)-235.5(h).7(as)-235.3(been)-235.5(repo)-15.5(r)11.1(t).5(ed)-235.5(by)-235.5(Ito)]TJ
/F9 1 Tf
13.973 0 TD
[(et)-235.7(al.)]TJ
/F5 1 Tf
2.1484 0 TD
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[(\()-15.9(3)10.7(7\),)-238.2(but)-236(dise)-15.9(a)8.4(s).5(e-)-15.9(f)10.8(r).3(ee)]TJ
-16.1214 -1.1174 TD
[(a)-15.9(n)9.5(d)-212.8(ove)-15.9(r)9.6(a)-.9(ll)-213(s)-15.9(u)10.9(rvi)-15.9(v)10.6(a)-.9(l)-213(w)-.6(er)-15.9(e)-203.5(s).5(imil)-15.9(a)9.4(r)-212.8(to)-212.8(sp)-15.9(o)10.7(r).3(ad)-15.9(i)10.6(c)-214(case)-15.9(s)9.7(.)-209.4(I)-15.9(n)-202.4(t).2(he)-214(s)-15.9(t)10.8(udy)]TJ
0 -1.1116 TD
0 Tc
[(by)-163.5(P)16.3(a)15(r)16.2(k)]TJ
/F9 1 Tf
3.1218 0 TD
[(et)-164.8(a)16.2(l)16.1(.)]TJ
/F5 1 Tf
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0 -1.1174 TD
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0 -1.1116 TD
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T*
[(er)25.5(a)15(t)16.1(io)26.5(n)16.2(.)-216.5(M)15.3(a)15(ze)24.3(h)]TJ
/F9 1 Tf
6.0419 0 TD
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[(et)-235.7(al.)]TJ
/F5 1 Tf
2.1484 0 TD
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[(\()-15.9(3)10.7(9\))-235.8(foun)-15.9(d)-219.7(t).2(ha)-15.9(t)-221(f).3(a)-15.9(m)8.3(ilia)-15.9(l)-221(D)-.6(TC)-236.9(pati)-15.9(e)9.4(n).3(ts)-235.7(had)]TJ
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0 -1.1116 TD
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T*
0 Tc
[(Ro)25.6(b)16.2(e)15(ns)26.8(h)16.2(t)16(ok)]TJ
/F9 1 Tf
4.89 0 TD
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[(et)-258.7(al.)]TJ
/F5 1 Tf
2.1945 0 TD
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-7.0844 -1.1116 TD
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0 -1.1116 TD
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T*
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T*
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[(s)-16.2(y)10.6(ndr)-16.2(o)10.4(m)-1.2(e)-254.6(\(41\))-16.2(.)]TJ
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[(preventing)-376.4(or)-376.6(reducing)-374.1(recurrence)-379.6(and)-373.1(deaths,)-369.4(since)-376.4(no)-370.8(in-)]TJ
0 -1.1174 TD
[(terventiona)-10.2(l)-312.3(screening)-324.3(programs)-316.2(have)-317.8(ever)-323.5(been)-317.8(reported)-316.5(in)]TJ
0 -1.1116 TD
[(at-risk)-348.7(family)-349(members.)-349.8(Patients)-345.2(with)-345.4(familial)-352.7(DTC)-346.2(should)]TJ
T*
[(have)-202.6(a)-198.1(careful)-201.3(history)-197.8(and)-200.3(directed)-202.6(neck)-196.8(exam)-8(ination)-199.3(as)-199(a)-198.1(part)]TJ
T*
[(of)-497.5(routine)-498.7(health)-504.5(maintenance.)-500.9(One)-494.9(should)-501.9(also)-495.1(consider)]TJ
0 -1.1174 TD
[(thyroi)-6.8(d)-277.6(cancer)-281.9(syndromes)-282.6(as)-285.4(noted)-277.5(above)-284.3(\(41\).)]TJ
/F10 1 Tf
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[([A3])-270.7(W)17.5(h)13.3(a)14.6(t)-248.7(is)-241.9(t)16.9(h)13.3(e)-251(a)14.6(p)19.6(p)13.3(ro)25.3(p)19.6(r)0(i)27.4(a)14.5(t)16.9(e)-251(l)15.4(a)14.5(b)13.3(o)13.3(r)0(a)32.8(t)0(o)23.8(r)18.3(y)-251(a)14.6(n)13.3(d)-252.2(i)15.4(m)18.8(a)14.5(g)13.3(i)15.4(n)13.3(g)]TJ
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[(discover)-14.3(e)18.5(d)-336.1(thyr)-14.3(o)17.3(i)-14.3(d)-320.7(nod)5.3(ules?)]TJ
/F12 1 Tf
1.1128 -1.8336 TD
0 Tc
[([A4])-338.2(Serum)-333(thyrotropin)-333.4(measurement)]TJ
/F11 1 Tf
5.9777 0 0 5.9777 312.2645 330.633 Tm
(&)Tj
/F1 1 Tf
8.9663 0 0 8.9663 322.7527 328.1385 Tm
[(RECOMMENDATION)-284.2(2)]TJ
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9.843 0 0 9.843 323.2629 311.6975 Tm
[(\(A\))-303.6(Serum)-301.4(thyrot)-6.8(ropin)-299.3(\(TSH\))-306.9(should)-306(be)-302.9(measured)-307.1(during)]TJ
0 -1.1116 TD
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[(\(Strong)-279.2(recommendation,)-290.2(Moderate-quality)-282.3(evidence\))]TJ
/F5 1 Tf
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15.9717 0 TD
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/F7 1 Tf
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[(and)-286.7(physical)-287.7(examination)-293.7(focusing)-286.3(on)-284.4(the)-286.8(thyroid)-284.4(gland)-289(and)]TJ
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[(adjacent)-376.6(cervical)-370.8(lymph)-369.7(nodes)-375.1(should)-369.4(be)-366.2(performed.)-373.9(Perti-)]TJ
T*
[(nent)-351.3(historical)-347.7(factors)-349.7(predicting)-353.5(malignancy)-350.1(include)-350.1(a)-347.8(his-)]TJ
0 -1.1174 TD
[(tory)-223.4(of)-215.3(childhood)-224.4(head)-219.8(and)-217.6(neck)-219.8(radiation)-225.7(therapy,)-220.9(total)-220.2(body)]TJ
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[(radiation)-323.6(for)-314.3(bone)-316.6(marrow)-315.1(transplantation)-319.9(\(42\),)-318.8(exposure)-316.2(to)]TJ
T*
[(ionizing)-344.4(radiation)-340.9(from)-339.6(fallout)-343.3(in)-336.4(childhood)-345.4(or)-336.2(adolescence)]TJ
0 -1.1174 TD
[(\(43\),)-232.4(familial)-231.7(thyroid)-232.6(carcinoma,)-232.4(or)-226.8(thyroid)-232.6(cancer)-230.1(syndrome)]TJ
0 -1.1116 TD
[(\(e.g.,)-504.3(PTEN)-502.8(hamartoma)-505.5(tumor)-502.2(syndrome)-506.3([Cowdens)-508.1(dis-)]TJ
T*
[(ease],)-277.1(FAP,)-272.2(Carney)-280.6(complex,)-274(Werner)-276.1(syndrome/progeria,)-274.5(or)]TJ
0 -1.1174 TD
[(MEN)-219.4(2,)-211.9(a)-209.6(risk)-211.7(for)-216.3(medullary)-215.3(thyroid)-209.5(cancer)-218.6([MTC]\))-217(in)-209.7(a)-215.4(rst-)]TJ
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[(degree)-557.2(relative,)-557.5(rapid)-559.7(nodule)-555.1(growth,)-552.4(and/or)-555(hoarseness.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(10)Tj
46.7832 0 TD
[(HAUGEN)-334.7(ET)-338.7(AL.)]TJ
ET
endstream
endobj
718 0 obj
<>stream
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BT
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0 0 0 rg
0 Tc
0 Tw
[(Pertinent)-375.3(physical)-374.1(ndings)-370.3(suggesting)-374.9(possible)-372.7(malignancy)]TJ
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[(include)-252.2(vocal)-249.9(cord)-247.4(paralysis,)-251.7(cervical)-255.6(lymphadenopathy,)-249.6(and)]TJ
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[(1)-162.4(c)0(m)-350.2(i)0(n)-342.1(any)-344.3(di-)]TJ
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[(TSH)-442.9(is)-434.1(subnormal,)-441.9(a)-440(radionuclide)-437.5(thyroid)-439.9(scan)-438.5(should)-438.5(be)]TJ
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[(obtained)-195.7(to)-192.4(document)-191.1(whether)-195.3(the)-188.9(nodule)-192.2(is)-192.2(hyperfunctioning)]TJ
T*
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[(normal)-274(thyroid\),)-277.4(isofunctioning)-270.3(\()49.7(warm,)44.4()-271.8(i.e.,)-273(tracer)-275.1(uptake)]TJ
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[(is)-595.4(equal)-601.2(to)-595.6(the)-592.1(surrounding)-599.5(thyroid\),)-594.2(or)-595.4(nonfunctioning)]TJ
T*
[(\()49.7(cold,)46.3()-381.2(i.e.,)-388.2(has)-384.4(uptake)-383.4(less)-385.4(than)-385.8(the)-384.7(surrounding)-386.4(thyroid)]TJ
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T*
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T*
[(subclinical)-263.6(hyperthyroidism)-261(is)-261.3(present,)-261(additional)-261.5(evaluation)]TJ
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[(part)-287.9(of)-290.1(the)-286.8(reference)-292.1(range,)-293.5(is)-284.4(associated)-292(with)-287.8(increased)-290.9(risk)]TJ
T*
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[(stage)-284.2(thyroid)-284.4(cancer)-281.9(\(45,46\).)]TJ
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8.9663 0 0 8.9663 69.7323 505.9841 Tm
[([A5])-331.9(Serum)-339.3(thyroglobulin)-336.9(measurement)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(3)]TJ
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[(Routine)-505.5(measurement)-514.5(of)-503.3(serum)-508.8(thyroglobulin)-510.1(\(Tg\))-506.6(for)]TJ
T*
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[(\(Strong)-279.2(recommendation,)-284.5(Moderate-q)-10.6(uality)-277.4(evidence\))]TJ
/F5 1 Tf
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[(Serum)-289.9(Tg)-291.4(levels)-291.2(can)-293.6(be)-285.6(elevated)-295.9(in)-290.3(most)-287.8(thyroid)-290.2(diseases)]TJ
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(\(4749\).)Tj
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[([A6])-331.9(Serum)-339.3(calcitonin)-333.6(measurement)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(4)]TJ
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[(The)-264.8(panel)-267.2(cannot)-268.3(recommend)-269.3(either)-268.3(for)-268.2(or)-261.4(against)-269.3(routine)]TJ
T*
[(measurement)-301.4(of)-295.9(serum)-295.7(calcitonin)-297.2(in)-296.1(patients)-299.3(with)-299.3(thyroid)]TJ
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(nodules.)Tj
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[(\(No)-280.6(recommendation,)-284.5(Insufcient)-284.2(evidence\))]TJ
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[(The)-420.4(utility)-417.3(of)-416.9(serum)-416.6(calcitonin)-418.2(has)-419(been)-421.4(evaluated)-418(in)-417(a)]TJ
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[(series)-250.5(of)-244.1(prospective,)-249.5(nonrandomized)-249.5(studies)-244.9(\(5054\).)-247.2(These)]TJ
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[(data)-479.2(suggest)-480.9(that)-472.4(the)-476.9(use)-476.6(of)-480.2(routine)-475.6(serum)-480(calcitonin)-475.8(for)]TJ
T*
[(screening)-497.1(may)-495.3(detect)-494.2(C-cell)-494(hyperplasia)-499.5(and)-494(MTC)-490.3(at)-493.1(an)]TJ
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[(earlier)-575.8(stage,)-564.1(and)-568.9(overall)-569(survival)-568.7(consequently)-575.5(may)-564.4(be)]TJ
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[(improved.)-561.9(However,)-562.4(most)-558.5(studie)-7.8(s)-553.8(relied)-562.1(on)-560.9(pentagastrin)]TJ
T*
[(stimulation)-389.3(testing)-389.2(to)-382.5(increase)-393.5(specicity.)-386.6(This)-391.4(drug)-384.5(is)-382.3(not)]TJ
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[(available)-556.4(in)-549.5(the)-546(United)-550.3(States,)-553.7(Canada,)-550.2(and)-545.9(some)-553.8(other)]TJ
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[(countries,)-309.5(and)-304(there)-307.4(remain)-304(unresolved)-307(issues)-306.8(of)-301.7(sensitivity,)]TJ
T*
[(specicity,)-323.2(assay)-318.5(performance,)-320.8(cut-offs)-315.1(using)-316.5(calci)-9.3(um)-314.4(stim-)]TJ
T*
[(ulation)-291.5(\(55\),)-290(and)-286.7(cost)-287.7(effectiveness.)-294.1(Two)-287.6(retrospective)-295.6(stud-)]TJ
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[(MTC)-190.7(after)-192.2(routine)-187.7(calcitonin)-193.6(testing)-187.6(compared)-192.1(with)-189.8(historical)]TJ
T*
[(controls)-332.6(\(53,56\),)-330.2(but)-331.7(they)-334(were)-330.1(unable)-331.6(to)-330.6(show)-333.4(a)-330.6(decreased)]TJ
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[(number)-204.8(of)-203.8(MTC-related)-203.2(deaths.)-208.1(A)-197.8(cost-effectiveness)-210.8(analysis)]TJ
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[(suggested)-213.6(that)-207.4(calcitonin)-210.8(screening)-209.1(would)-208.1(be)-210.7(cost)-207.1(effective)-210.6(in)]TJ
T*
[(the)-459.6(United)-452.4(States)-458.1(\(57\).)-451.3(However,)-458.7(prevalence)-460.4(estimates)-458.1(of)]TJ
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[(MTC)-409.6(in)-399.7(this)-407.6(analysis)-402.7(included)-408.8(patients)-408.8(with)-403(C-cell)-407.6(hyper-)]TJ
0 -1.1116 TD
[(plasia)-302.7(and)-292.4(microMTC,)-300.1(which)-301.4(have)-294.7(uncertain)-301.6(clinical)-300.8(signif-)]TJ
T*
[(icance.)-216.4(Based)-210.3(on)-209.5(the)-206.2(retrospective)-214.9(nature)-210.6(of)-209.5(the)-206.2(survival)-211.6(data,)]TJ
T*
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25.5097 67.9184 TD
[(cost-effective)-269(analysis,)-267.9(the)-269.5(task)-264.7(force)-267(cannot)-268.3(recommend)-269.3(for)]TJ
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[(or)-295.9(against)-298.1(the)-292.6(routine)-297.1(measurement)-301.4(of)-295.9(serum)-295.7(calcitonin)-303(as)-291.1(a)]TJ
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T*
[(was)-321.9(not)-320.2(uniform)-325.8(agreement)-326.9(on)-319(this)-321.2(recommendation.)-325.7(There)]TJ
T*
[(was,)-573(however,)-573(agreement)-574.6(that)-576(serum)-572.1(calcitonin)-573.7(may)-575.9(be)]TJ
0 -1.1174 TD
[(considered)-302.4(in)-296.1(the)-298.3(subgroup)-296.6(of)-295.9(patients)-305.1(in)-296.1(whom)-300.3(an)-297.1(elevated)]TJ
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[(calcitonin)-389.4(may)-385.8(change)-390.2(the)-390.5(diagnostic)-387.9(or)-388.1(surgical)-391.3(approach)]TJ
T*
[(\(i.e.,)-389.2(patients)-391.5(considered)-388.8(for)-389.1(less)-391.2(than)-391.6(total)-387.2(thyroidectomy,)]TJ
0 -1.1174 TD
[(patients)-195.6(with)-195.6(suspicious)-196.2(cytology)-194.5(not)-193.5(consistent)-197.7(with)-195.6(PTC\).)-199.9(If)]TJ
0 -1.1116 TD
[(the)-442.3(unstimulated)-443.3(serum)-439.6(calcitonin)-447(determination)-445.8(has)-442(been)]TJ
T*
[(obt)13.8(ain)12.7(ed)-279.8(and)-280.9(the)-281.1(lev)12.7(el)-285.7(is)-284.4(gre)12.8(ate)11.5(r)-289.1(tha)12.7(n)-289.1(50)14(100)-147.3(pg/)13.8(mL,)-284.5(a)-290.2(dia)18.4(g-)]TJ
0 -1.1174 TD
[(nos)14.2(is)-267.1(of)-272.9(MTC)-265.6(is)-272.8(com)11.6(mo)13.9(n)-277.6(\(58)14(\).)]TJ
1.0137 -1.1116 TD
.0109 Tc
[(Th)4(er)4.1(e)-411.8(i)3.9(s)-416.2(e)2.9(mer)4.1(g)4(in)4(g)-410.7(e)-2.9(v)4(i)3.9(dence)-411.8(t)3.9(hat)-410.8(a)-411.8(cal)3.9(c)-2.9(i)3.9(t)-1.8(o)4(n)4(i)-1.8(n)-410.7(m)2.8(eas)4.2(u)-1.7(r)4.1(e)2.9(-)]TJ
-1.0137 -1.1116 TD
.0072 Tc
[(men)-5.4(t)-397.2(fr)-5.4(om)-398.3(a)-398.2(t)-5.5(hyr)-5.4(oid)-402.8(nod)-5.4(ul)-5.5(e)-398.2().5(ne)-6.6(-n)-5.4(eed)-5.4(le)-398.2(as)-5.2(pi)-5.5(rat)-5.5(i).2(o)-5.4(n)-397.1(\(F)-5.3(NA\))]TJ
T*
.0109 Tc
[(wash)4(ou)4(t)-370.5(m)2.8(ay)-370.3(b)4(e)-371.5(h)4(e)-2.9(l)3.9(p)4(fu)4(l)-370.5(i)3.9(n)-370.3(t)3.9(he)-365.7(pr)4.1(eop)4(e)2.9(rati)3.9(v)4(e)-371.5(eval)3.9(uati)3.9(o)4(n)-370.3(o)4(f)]TJ
0 -1.1174 TD
.0073 Tc
[(pat)-5.4(i).3(e)-6.5(n).4(ts)-431.3(wi)-5.4(th)-431.5(a)-426.9(m)-6.5(ode)-6.5(st)-5.4(ly)-431.5(ele)-6.5(v).4(at)-5.4(ed)-431.5(ba)-6.5(sal)-431.7(s).6(e)-6.5(r).5(u)-5.3(m)-427(ca)-6.5(lci)-5.4(t).3(o)-5.3(n).4(in)]TJ
0 -1.1116 TD
.0071 Tc
[(\(2)-5.5(01)-5.5(00)-166.8(p)-5.5(g).2(/)-5.6(m)-1(L\))-281.9(\()-5.5(59\))-5.5(.)]TJ
/F12 1 Tf
8.9663 0 0 8.9663 320.8251 529.8518 Tm
0 Tc
[([A7])-331.9([)]TJ
6.7246 0 0 5.9768 342.255 533.877 Tm
(18)Tj
8.9663 0 0 8.9663 349.7385 529.8518 Tm
[(F]Fluorodeoxyglucose)-331.3(positron)-336(emission)]TJ
-4.3375 -1.2203 TD
[(tomography)-330.5(scan)]TJ
/F11 1 Tf
5.9777 0 0 5.9777 310.0535 497.9904 Tm
(&)Tj
/F1 1 Tf
8.9663 0 0 8.9663 320.485 495.4959 Tm
[(RECOMMENDATION)-284.1(5)]TJ
/F5 1 Tf
9.843 0 0 9.843 320.9952 480.0754 Tm
[(\(A\))-367(Focal)-364.9([)]TJ
7.3823 0 0 6.5614 367.0298 484.4408 Tm
(18)Tj
9.843 0 0 9.843 374.3999 480.0754 Tm
[(F]uorodeoxyglucose)-369.6(positron)-365.9(emission)-368.2(to-)]TJ
-5.4256 -1.1174 TD
[(mography)-316.4(\()]TJ
7.3823 0 0 6.5614 367.37 473.4991 Tm
(18)Tj
9.843 0 0 9.843 374.7968 469.077 Tm
[(FDG-PET\))-317.8(uptake)-320.1(within)-313.1(a)-319(sonographically)]TJ
-5.466 -1.1116 TD
[(conrmed)-461.4(thyroid)-463(nodule)-457.2(conveys)-464.9(an)-458.4(increased)-463.7(risk)-465.1(of)]TJ
T*
[(thyroid)-324.7(cancer,)-325.7(and)-321.2(FNA)-327.4(is)-324.7(recommended)-324.5(for)-325.8(those)-323.4(nod-)]TJ
T*
(ules)Tj
/F6 1 Tf
1.8949 0 TD
()Tj
/F5 1 Tf
.5529 0 TD
[(1)-168.1(cm.)]TJ
/F7 1 Tf
-2.4479 -1.6703 TD
[(\(Strong)-285(recommendation,)-284.5(Moderate-quality)-288(evidence\))]TJ
/F5 1 Tf
0 -1.8258 TD
[(B\))-423.7(Diffuse)]TJ
7.3823 0 0 6.5614 368.6739 406.2046 Tm
(18)Tj
9.843 0 0 9.843 376.1007 401.8393 Tm
[(FDG-PET)-420.4(uptake,)-427.2(in)-422.8(conjunction)-423.8(with)-426(so-)]TJ
-5.5984 -1.1116 TD
[(nographic)-404(and)-396.1(clinical)-404.5(evidence)-405.3(of)-393.8(chronic)-401.8(lymphocytic)]TJ
T*
[(thyroiditis,)-280.9(does)-281.8(not)-279.9(require)-286.6(further)-279.6(imaging)-286.8(or)-278.6(FNA.)]TJ
/F7 1 Tf
0 -1.6703 TD
[(\(Strong)-285(recommendation,)-284.5(Moderate-quality)-288(evidence\))]TJ
/F5 1 Tf
7.3823 0 0 6.5614 320.8251 345.9401 Tm
(18)Tj
9.843 0 0 9.843 328.1952 341.5747 Tm
[(FDG-PET)-316.8(is)-313.2(increasingly)-316.4(performed)-312.9(during)-312(the)-315.6(evalua-)]TJ
-1.7625 -1.1116 TD
[(tion)-379(of)-382.3(patients)-380(with)-379.9(both)-384.7(malignant)-382.5(and)-378.8(nonmalignant)-385.8(ill-)]TJ
T*
[(ness.)-210.2(While)]TJ
7.3823 0 0 6.5614 358.5826 324.0566 Tm
(18)Tj
9.843 0 0 9.843 365.9527 319.6913 Tm
[(FDG-PET)-213.1(imaging)-211.9(is)-215.2(not)-210.8(recommended)-215(for)-210.6(the)]TJ
-5.5984 -1.1174 TD
[(evaluation)-366.2(of)-365(patients)-368.4(with)-362.6(newly)-370.5(detected)-365.1(thyroid)-365(nodules)]TJ
0 -1.1116 TD
[(or)-497.5(thyroidal)-506.8(illness,)-501.9(the)-505.7(incidental)-504.6(detection)-503.4(of)-503.3(abnormal)]TJ
T*
[(thyroid)-203.8(uptake)-204.9(may)-201.5(nonetheless)-211.3(be)-199.2(encountered.)-210.4(Importantly,)]TJ
0 -1.1174 TD
(incidental)Tj
7.3823 0 0 6.5614 353.9904 280.1763 Tm
(18)Tj
9.843 0 0 9.843 361.3605 275.8109 Tm
[(FDG-PET)-420.4(uptake)-412.2(in)-417(the)-413.5(thyroid)-416.9(gland)-410(can)-420.3(be)]TJ
-5.1319 -1.1116 TD
[(either)-302.9(focal)-307.4(or)-307.4(diffuse.)-305.9(Focal)]TJ
7.3823 0 0 6.5614 428.1448 269.2346 Tm
(18)Tj
9.843 0 0 9.843 435.5148 264.8692 Tm
[(FDG-PET)-311(uptake)-302.8(in)-307.6(the)-304.1(thy-)]TJ
-12.6656 -1.1116 TD
[(roid)-286.7(is)-284.4(incidentally)-288.1(detected)-290.2(in)-290.3(1%2%)-284.1(of)-284.4(patients,)-291.2(while)-290(an)]TJ
0 -1.1174 TD
[(additional)-250(2%)-245.2(of)-244.1(patients)-247.5(demonstrate)-253(diffuse)-244.9(thyroid)-244.1(uptake)]TJ
0 -1.1116 TD
(\(6062\).)Tj
1.0137 -1.1116 TD
[(Focal)-203.6(thyroid)-209.5(uptake)-210.7(most)-207.2(often)-208.4(corresponds)-209.8(to)-203.9(a)-209.6(clinically)]TJ
-1.0137 -1.1174 TD
[(relevant)-450.3(thyroid)-451.4(nodule,)-449.1(and)-453.7(US)-446.4(examination)-455(is)-451.4(thus)-447.8(rec-)]TJ
0 -1.1116 TD
[(ommended)-503.2(to)-497.7(dene)-503(thyroid)-497.5(anatomy.)-504.4(Importantly,)-502.1(focal)]TJ
7.3823 0 0 6.5614 310.8472 192.5291 Tm
(18)Tj
9.843 0 0 9.843 318.2172 188.1637 Tm
[(FDG-PET)-282.2(uptake)-274(increases)-279.2(malignancy)-280.9(risk)-275(in)-273(an)-279.8(affected)]TJ
-.7488 -1.1116 TD
[(nodule,)-212.9(and)-211.8(therefore)-215(clinical)-220.2(evaluation)-216.5(and)-211.8(FNA)-212.2(of)-209.5(nodules)]TJ
/F6 1 Tf
0 -1.1174 TD
()Tj
/F5 1 Tf
.5529 0 TD
[(1)-162.4(c)0(m)-200.4(i)0(s)-203.7(recommended.)]TJ
7.3823 0 0 6.5614 405.8077 170.5889 Tm
(18)Tj
9.843 0 0 9.843 413.2345 166.2236 Tm
[(FDG-PET)-201.6(positive)-200.2(thyroid)-198(nodules)]TJ
/F6 1 Tf
-10.402 -1.1116 TD
(<)Tj
/F5 1 Tf
.5529 0 TD
[(1)-162.4(c)0(m)-194.7(that)-190.1(do)-192.3(not)-193.5(meet)-192.4(FNA)-189.2(criteria)-196.9(\(see)-196.6(Recommendation)-196.6(8\))]TJ
-.5529 -1.1116 TD
[(can)-259.1(be)-256.8(monitored)-260.2(similarly)-260.3(to)-261.5(thyroid)-255.6(nodules)-262.2(with)-259(high-risk)]TJ
0 -1.1174 TD
[(so)21(no)15.1(gr)15.1(ap)19.7(hi)14.9(c)-273(p)0(a)13.9(t)0(t)20.6(e)0(r)14(n)0(s)-267(t)0(h)20.7(a)0(t)-268.4(d)0(o)-267.1(n)0(o)15.1(t)-271.9(me)12.7(et)-268.4(FN)20.1(A)-278.4(c)0(r)19.7(i)0(t)14.8(e)0(r)19.7(i)0(a)-268.4(\()0(s)15.3(e)0(e)-269.5(R)0(e)18.6(c)0(-)]TJ
0 -1.1116 TD
[(om)19.6(me)18.4(nd)15.1(at)19.5(io)15(n)-427.3(2)0(4)15.1(A)0(\))20(.)-429.6(A)-428.2(r)0(e)19.7(c)0(e)12.8(n)0(t)-417(m)0(e)18.4(t)0(a)13.8(-)0(a)19.7(n)0(a)13.9(l)0(y)20.7(s)0(i)15.1(s)-427.1(co)19.7(n)15.3(rm)19.6(ed)-423.8(th)20.7(at)]TJ
T*
[(approximately)-457.1(one)-453.7(in)-451.6(three)-457.2(\()]TJ
/F13 1 Tf
12.1818 0 TD
(*)Tj
/F5 1 Tf
1.0022 0 TD
(35%\))Tj
7.3823 0 0 6.5614 466.4125 115.8235 Tm
(18)Tj
9.843 0 0 9.843 473.7825 111.4582 Tm
[(FDG-PET)-460.8(positive)]TJ
-16.5534 -1.1174 TD
[(thyroid)-439.9(nodules)-435(proved)-439.7(to)-440.1(be)-435.3(cancerous)-440.6(\(60\),)-439.7(with)-437.5(higher)]TJ
0 -1.1116 TD
[(mean)-555.1(maximum)-554.1(standardized)-553.6(uptake)-556.2(value)-555.1(in)-549.5(malignant)]TJ
T*
[(compared)-295.7(to)-296.1(benign)-295.9(nodules)-296.8(\(6.9)-294.7(vs.)-299.2(4.8,)]TJ
/F9 1 Tf
16.8644 0 TD
(p)Tj
/F6 1 Tf
.6681 0 TD
(<)Tj
/F5 1 Tf
.72 0 TD
[(0.001\).)-294.6(In)-295.9(con-)]TJ
-18.2525 -1.1174 TD
[(trast,)-453.6(diffuse)-452.2(thyroid)-451.4(uptake)-452.6(most)-449.1(often)-456(represents)-451.9(benign)]TJ
0 -1.1116 TD
[(disease)-304.7(corresponding)-304.5(to)-301.8(inammatory)-305(uptake)-308.6(in)-301.8(the)-298.3(setting)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ATA)-340.1(THYROID)-334.7(NODULE/DTC)-339.7(GUIDELINES)]TJ
53.5677 0 TD
(11)Tj
ET
endstream
endobj
724 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
9.843 0 0 9.843 62.022 725.1588 Tm
0 0 0 rg
0 Tc
0 Tw
[(of)-474.5(Hashimotos)-481.8(disease)-483.2(or)-474.5(other)-479.1(diffuse)-475.3(thyroidal)-478(illness.)]TJ
0 -1.1174 TD
[(However,)-550.8(if)-549.5(detected,)-552.8(diffuse)]TJ
7.3823 0 0 6.5614 191.0551 718.5825 Tm
(18)Tj
9.843 0 0 9.843 198.4251 714.1605 Tm
[(FDG-PET)-552.9(uptake)-550.5(in)-543.7(the)]TJ
-13.8579 -1.1116 TD
[(thyroid)-330.5(should)-329.1(also)-328(prompt)-324.7(sonographic)-331.1(examination)-334(to)-324.9(en-)]TJ
T*
[(sure)-397(there)-399.6(is)-399.6(no)-399.6(evidence)-399.5(of)-393.8(clinically)-401.1(relevant)-404.2(nodularity.)]TJ
T*
[(Most)-350.8(patients)-356.9(with)-356.9(diffuse)]TJ
7.3823 0 0 6.5614 171.7795 685.7006 Tm
(18)Tj
9.843 0 0 9.843 179.1496 681.3352 Tm
[(FDG-PET)-357.1(uptake)-354.6(demonstrate)]TJ
-11.8996 -1.1174 TD
[(diffuse)-417.7(heterogeneity)-416.8(on)-411.1(sonographic)-417.5(examination,)-418.1(and)-413.4(no)]TJ
0 -1.1116 TD
[(further)-337.2(intervention)-332.8(or)-330.5(FNA)-338.9(is)-330.4(required.)-337.2(It)-330.6(is)-330.4(appropriate)-338.3(to)]TJ
T*
[(evaluate)-284.4(thyroid)-284.4(function)-280.9(in)-278.8(these)-284.2(patients.)]TJ
/F12 1 Tf
8.9663 0 0 8.9663 72 626.5132 Tm
[([A8])-331.9(Thyroid)-333.7(sonography)]TJ
/F11 1 Tf
5.9777 0 0 5.9777 61.2283 604.1195 Tm
(&)Tj
/F1 1 Tf
8.9663 0 0 8.9663 71.6598 601.6251 Tm
[(RECOMMENDATION)-290.5(6)]TJ
/F5 1 Tf
9.843 0 0 9.843 72.1701 590.6266 Tm
[(Thyroid)-446.7(sonography)-443.9(with)-443.3(survey)-445.3(of)-445.7(the)-442.3(cervical)-451.4(lymph)]TJ
T*
[(nodes)-323.3(should)-323.3(be)-320.1(performed)-324.4(in)-319.1(all)-321.5(patients)-322.4(with)-322.3(known)-323.2(or)]TJ
T*
[(suspected)-283.8(thyroid)-284.4(nodules.)]TJ
/F7 1 Tf
0 -1.6703 TD
[(\(Strong)-285(recommendation,)-284.5(High-quality)-285(evidence\))]TJ
/F5 1 Tf
-.0173 -2.229 TD
[(Diagnostic)-434.9(thyroid/neck)-430.6(US)-429.1(should)-432.8(be)-429.6(performed)-433.8(in)-428.5(all)]TJ
-1.0137 -1.1116 TD
[(patients)-339.6(with)-333.8(a)-336.3(suspected)-335.7(thyroid)-336.2(nodule,)-339.6(nodular)-331.5(goiter,)-339.7(or)]TJ
T*
[(radiographic)-368.2(abnormality)-361.6(suggesting)-363.4(a)-359.4(thyroi)-6.8(d)-358.2(nodule)-359.2(inci-)]TJ
0 -1.1174 TD
[(dentally)-322.5(detected)-324.7(on)-319(another)-321.2(imaging)-321.4(study)-322.2(\(e.g.,)-320(computed)]TJ
0 -1.1116 TD
[(tomography)-526.1([CT])-519.2(or)-520.5(magnetic)-526.4(resonance)-527(imaging)-517.2([MRI])]TJ
T*
[(or)-428.4(thyroidal)-431.9(uptake)-429.5(on)]TJ
7.3823 0 0 6.5614 158.9669 479.9621 Tm
(18)Tj
9.843 0 0 9.843 166.3936 475.5967 Tm
[(FDG-PET)-426.2(scan\))-433.8(\(www.aium.org/)]TJ
-10.6036 -1.1174 TD
[(resources/guidelines/thyroid.pdf\).)-520.4(Thyroid)-510.1(US)-504(can)-512.5(answer)]TJ
0 -1.1116 TD
[(the)-379(following)-379.8(questions:)-380.8(Is)-376.4(there)-382.3(truly)-374.3(a)-376.6(nodule)-382.3(that)-380.2(corre-)]TJ
T*
[(sponds)-190.5(to)-180.9(an)-187.7(identied)-191(abnormality?)-191.1(How)-189.4(large)-186.5(is)-186.4(the)-188.9(nodule?)]TJ
0 -1.1174 TD
[(What)-186.5(is)-186.4(the)-188.9(nodules)-182.7(pattern)-188.8(of)-186.5(US)-187.2(imaging)-183.2(chara)-9(cteristics?)-189.7(Is)]TJ
0 -1.1116 TD
[(suspicious)-294.1(cervical)-290.2(lymphadenopathy)-292.2(present?)-294.4(Is)-284.2(the)-292.6(nodule)]TJ
T*
[(greater)-276.2(than)-270.6(50%)-269.3(cystic?)-276.2(Is)-272.7(the)-269.5(nodule)-272.9(located)-276.4(posteriorly)-272.6(in)]TJ
T*
[(the)-223.5(thyroid)-221(gland?)-222.2(These)-227.7(last)-218.7(two)-223.2(features)-225.3(might)-220.1(decrease)-227.5(the)]TJ
0 -1.1174 TD
[(accuracy)-285.3(of)-278.6(FNA)-287.1(biopsy)-277.2(performed)-284.1(with)-282(palpation)-283.3(\(63,64\).)]TJ
1.0137 -1.1116 TD
[(Ultrasound)-324.1(should)-329.1(evaluate)-324.7(the)-327.1(following:)-329.2(thyroid)-324.7(paren-)]TJ
-1.0137 -1.1116 TD
[(chyma)-204.9(\(homogeneous)-206.6(or)-203.8(heterogeneous\))-210(and)-206.1(gland)-202.6(size;)-209.5(size,)]TJ
0 -1.1174 TD
[(location,)-320.2(zand)-323.5(sonographic)-319.6(chara)-9(cteristics)-319.9(of)-319(any)-321.2(nodule\(s\);)]TJ
0 -1.1116 TD
[(the)-419.3(presence)-422.2(or)-416.9(absence)-421.1(of)-422.6(any)-419.2(suspicious)-420.8(cervical)-422.6(lymph)]TJ
T*
[(nodes)-300.2(in)-296.1(the)-304.1(central)-299.4(or)-301.7(lateral)-299.5(compartments.)-304.9(The)-299.4(US)-302.4(report)]TJ
0 -1.1174 TD
[(should)-219.7(convey)-216.3(nodule)-215.3(size)-219.8(\(in)-216.5(three)-221(dimensions\))-215.9(and)-217.6(location)]TJ
0 -1.1116 TD
[(\(e.g.,)-297(right)-293.7(upper)-294.6(lobe\))-294.8(and)-292.4(a)-296(description)-296.8(of)-295.9(the)-292.6(nodules)-297.9(so-)]TJ
T*
[(nographic)-306.1(features)-305.9(including)-305.2(composition)-302.7(\(solid,)-303.8(cystic)-302.7(pro-)]TJ
T*
[(portion,)-218.7(or)-215.3(spongiform\),)-212.5(echog)-7.8(enicity,)-215.4(margins,)-215(presence)-220.6(and)]TJ
0 -1.1174 TD
[(type)-489.5(of)-486(calcications,)-496(and)-488.3(shape)-485.7(if)-491.9(taller)-487.3(than)-489.5(wide,)-488.1(and)]TJ
0 -1.1116 TD
[(vascularity.)-382.1(The)-374.3(pattern)-378.9(of)-370.8(sonographic)-383(features)-375(associated)]TJ
T*
[(with)-362.6(a)-365.1(nodule)-365(confers)-361.1(a)-365.1(risk)-361.4(of)-365(malignancy,)-365(and)-361.6(combined)]TJ
0 -1.1174 TD
[(with)-310.8(nodule)-307.4(size,)-303.8(guides)-313(FNA)-304.4(decision-making)-315.2(\(65,66\))-303.7(\(see)]TJ
0 -1.1116 TD
[(Recommendation)-288.8(8\).)]TJ
1.0137 -1.1116 TD
-.0216 Tc
[(I)-21.6(n)-213.8(th)-5.4(e)-190.9(s)-5.2(ubs)-5.2(et)-195.6(of)-195.5(pati)-5.5(ent)-5.5(s)-189.5(w)-6.3(ith)-195.5(lo)-5.4(w)-190.6(s)-5.2(eru)-5.4(m)-190.9(TS)-5.3(H)-190.6(l)-5.5(eve)-6.6(l).2(s)-195.3(w)-.5(ho)-195.5(ha)-6.6(ve)]TJ
-1.0137 -1.1174 TD
[(un)-5.5(der)-5.5(gon)-5.5(e)-335(r).3(ad)-5.5(ionu)-5.5(cli)-5.6(d).2(e)-335(t).1(h)-5.5(y).2(ro)-5.5(id)-333.8(sc)-6.7(int)-5.6(i).1(gr)-5.5(aphy)-333.8(s)-5.3(u).2(g)-5.5(g).2(est)-5.7(i).1(ng)-333.8(n)-5.5(odu)-5.5(-)]TJ
0 -1.1116 TD
[(la)-6.6(rit)-5.5(y).3(,)-313(U)-.5(S)-316.3(s).5(h)-5.4(oul)-5.5(d)-310.7(a)-.8(l)-5.5(s).5(o)-316.4(b).3(e)-311.8(p)-5.4(erf)-5.4(o).3(rm)-6.6(ed)-310.7(t)-5.5(o)-310.7(e)-6.6(v).3(alu)-5.4(a)-.8(te)-317.6(bot)-5.5(h)-310.7(t)-5.5(he)-311.8(p)-5.4(r).4(es)-5.2(-)]TJ
T*
[(en)-5.4(ce)-265.8(of)-270.3(nodu)-5.4(les)-270.2(c)-.8(onc)-6.6(ord)-5.4(a)-.8(nt)-264.7(w)-6.3(ith)-270.4(the)-265.8(h)-5.4(yper)-5.4(f).4(un)-5.4(cti)-5.5(oni)-5.5(ng)-264.6(ar)-5.4(eas)-264.4(o)-5.4(n)]TJ
0 -1.1174 TD
[(th)-5.3(e)-282.9(s)-5.1(can)-5.3(,)-284.1(w)-.4(h)-5.3(i).3(ch)-287.5(do)-287.5(no)-5.3(t)-287.7(r).5(equ)-5.3(i).3(re)-288.7(F)-5.2(NA,)-289.9(as)-287.3(wel)-5.4(l)-281.9(a)-6.5(s)-281.6(o)-5.3(t).3(he)-6.5(r)-287.5(nonf)-5.3(unc)-6.5(-)]TJ
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
-.0159 Tc
[(ma)-15.9(r)9.6(g).3(ins)-299(o).3(r)-299.2(m)-.9(icroc)-15.9(a)8.4(l).2(ci)-15.9(c)9.7(ation)-15.9(s)-282.9(th)-15.9(a)9.5(n)-293.5(fo)-15.9(r)-283(hyp)-15.9(o)10.7(echoi)-15.9(c)-284.3(s).5(o)-15.9(l)10.6(id)-293.5(n)-15.9(o)10.7(d-)]TJ
0 -1.1174 TD
-.0157 Tc
[(u)-15.7(l)10.8(es)-350.7(lacki)-15.7(n)10.8(g)-345.1(t)-15.7(h)10.8(e)-.7(se)-352(featu)-15.7(r)10.9(es)-350.7(\(70\))-15.7(.)-337(M)-.4(acro)-15.7(c)9.7(alci)-15.7(c)9.9(atio)-15.7(n)10.9(s)-350.7(within)-350.9(a)]TJ
0 -1.1116 TD
[(n)-15.8(o)10.8(dule,)-289.9(if)-287.6(combin)-15.8(e)9.6(d)-281.8(w)-15.8(i)9.8(th)-287.6(microc)-15.8(a)8.5(l).3(cic)-15.8(a)8.5(tion)-15.8(s)11(,)-284.2(c)-.8(on)-15.8(f)10.8(e)-.8(r)-287.6(t).3(he)-288.8(same)]TJ
T*
[(ma)-15.7(l)9.6(i).4(gnan)-15.7(c)9.7(y)-195.3(r).5(i)-15.7(s)11(k)-195.3(a)-.7(s)-200.9(m)-.7(icro)-15.7(c)9.7(a)-.7(lci)-15.7(c)9.9(a)-.7(tio)-15.7(n)10.9(s)-195.1(al)-15.7(o)10.8(n).5(e)-196.5(\()-15.7(7)10.9(0).5(,74\).)-197.7(Ho)-15.7(w)10(e)-.7(ver,)]TJ
0 -1.1174 TD
[(t)-15.7(h)10.8(e)-449.9(pre)-15.7(s)9.9(e)-.7(nce)-449.9(o)-15.7(f)-438.3(t).4(his)-454.3(t).4(ype)-455.7(of)-448.7(int)-15.7(r)10.8(anod)-15.7(u)10.9(l).4(ar)-448.7(ma)-15.7(c)8.6(rocal)-15.7(c)9.6(i).4(cat)-15.7(i)10.6(o).5(n)]TJ
0 -1.1116 TD
[(a)-15.8(l)9.5(one)-185.1(is)-183.7(no)-15.8(t)-167.9(c)-15.8(o)9.6(n).4(sis)-15.8(t)10.9(ent)-15.8(l)10.5(y)-183.9(a)-.8(sso)-15.8(c)9.6(i).3(ated)-183.9(wi)-15.8(t)10.5(h)-183.9(thyr)-15.8(o)10.8(i).3(d)-183.9(cance)-15.8(r)-174.6(\(78\).)-186.3(On)]TJ
T*
[(t)-15.7(h)10.8(e)-317.5(o).5(t)-15.7(h)10.8(er)-316.3(h)-15.7(a)9.7(nd,)-318.6(a)-317.5(n)-15.7(o)10.9(dule)-323.2(t).4(hat)-322.2(h).5(as)-321.9(inter)-15.7(r)11(upte)-15.7(d)-307(per)-15.7(i)10.8(pher)-15.7(a)9.8(l)-316.4(cal)-15.7(c)9.6(i).4(-)]TJ
0 -1.1174 TD
0 Tc
[(c)25.6(a)15(t)16.1(i)16.1(o)0(n)26.6(s)16.4(,)-302.9(i)16.1(n)-300.6(a)15(s)16.4(s)0(o)26.8(c)15(i)16.1(a)15(ti)26.3(o)16.2(n)-300.6(w)15.3(i)0(t)26.3(h)-300.6(a)-301.8(s)16.4(of)26.6(t)-300.7(t)16.1(i)16.1(s)0(s)27(u)16.2(e)-301.8(r)16.2(im)-291.5(o)16.2(u)16.2(t)16.1(si)26.7(d)16.2(e)-301.8(t)16.1(h)16.2(e)-307.5(c)15(a)15(l)16.1(-)]TJ
0 -1.1116 TD
-.0158 Tc
[(c)-15.8(i)9.5(cati)-15.8(o)10.7(n,)-307.2(i)-15.8(s)-300.2(highl)-15.8(y)-294.6(l)-15.8(i)10.5(k).4(ely)-310.6(t).3(o)-310.6(b).4(e)-311.8(mali)-15.8(g)10.7(nant)-15.8(,)-296.9(a)-.8(nd)-310.6(th)-15.8(e)-295.6(a)-.8(s)-15.8(s)11.2(oci)-15.8(a)9.5(ted)]TJ
T*
0 Tc
[(pa)25.4(t)16.1(h)16.2(o)16.2(l)0(o)26.5(g)16.2(y)-271.8(m)15(a)15(y)-271.8(d)16.2(e)0(m)24.2(o)16.2(n)16.2(s)16.4(tr)26.5(a)15(t)16.1(e)-273(t)16.1(um)25.4(o)16.2(r)-271.8(i)16.1(n)16.2(va)25.4(s)16.4(i)16.1(o)16.2(n)-277.6(i)16.1(n)-271.8(t)16.1(h)16.2(e)-273(a)15(re)25.5(a)-273(o)16.2(f)-271.8(d)16.2(is)26.7(-)]TJ
0 -1.1174 TD
-.0157 Tc
[(r)-15.7(u)10.9(pted)-281.7(cal)-15.7(c)9.6(i).4(ca)-15.7(t)9.6(ion)-281.7(\(79)-15.7(,)14.3(8)-15.7(0)10.9(\)).5(.)]TJ
1.0137 -1.1116 TD
0 Tc
[(In)-422.6(a)-428.5(r)0(e)19.7(c)0(e)18.5(n)0(t)-422.8(s)0(t)20.9(u)0(d)20.8(y)-433.1(wh)20(er)19.7(e)-428.5(9)0(8)20.8(%)-434.1(of)-416.9(th)15(e)-428.5(c)0(a)18.5(n)0(c)19.7(e)0(r)19.7(s)-432.9(we)18.8(re)-418(PT)19.8(C,)]TJ
-1.0137 -1.1116 TD
[(in)15(tr)20.7(an)19.7(od)20.8(ul)20.7(ar)-337.4(va)19.7(sc)19.9(ul)20.7(ar)19.7(it)14.8(y)-340.9(d)0(i)20.7(d)-346.7(no)20.8(t)-346.8(h)0(a)19.7(v)0(e)-331.7(i)0(n)20.7(d)0(e)13.9(p)0(e)19.7(n)0(d)20.8(e)0(n)19.7(t)-341(pr)15.1(ed)19.7(ic)19.6(ti)20.6(ve)]TJ
25.5097 27.8309 TD
[(va)19.7(lu)20.7(e)-215.4(f)0(o)20.9(r)-214.2(ma)18.4(li)14.8(gn)20.8(an)19.7(cy)-205(in)-203.9(mu)19.6(lt)20.6(iv)20.7(ar)14(ia)19.6(te)-205.1(lo)20.7(gi)20.7(st)20.9(ic)-205.1(re)13.9(gr)20.9(es)19.9(si)20.9(on)-203.8(mo)19.6(de)19.7(l)]TJ
0 -1.1116 TD
[(in)20.7(cl)19.5(ud)20.8(in)20.7(g)-392.8(g)0(r)20.9(a)0(y)19.7(-)0(s)15.3(c)0(a)18.5(l)0(e)-377.9(f)0(e)14(a)0(t)19.5(u)0(r)20.9(e)0(s)-383.3(\()0(7)20.9(2)0(\))20.9(.)-395.1(T)15(w)0(o)-383.2(o)0(t)20.7(h)0(e)13.9(r)-387(st)15.1(ud)20.8(ie)19.6(s)-392.6(a)0(n)19.7(d)-392.8(a)]TJ
T*
[(me)18.4(ta)19.6(-a)19.7(na)19.7(ly)20.7(si)20.9(s)-479(w)0(i)19.8(t)0(h)-468.9(h)0(i)20.7(g)0(h)20.8(e)0(r)-469.9(p)0(r)20.9(o)0(p)20.8(o)0(r)20.9(t)0(i)20.6(o)0(n)15.1(s)-473.2(of)-468.7(fo)20.9(ll)20.6(ic)19.6(ul)20.7(ar)-469.9(th)20.7(yr)20.9(oi)20.7(d)]TJ
T*
[(ca)18.5(nc)19.7(er)-297.1(\(F)15.3(TC)18.6(\))-306.3(\()0(1)20.9(0)0(%)19.8()0(2)20.8(2)0(%)19.8(\))-312.1(ha)19.7(ve)-297.1(sh)15.3(ow)20(n)-306.4(t)0(h)20.7(a)0(t)-303(i)0(n)20.7(t)0(r)20.7(a)0(n)19.7(o)0(d)20.8(u)0(l)14.9(a)0(r)-297.1(v)0(a)19.7(s)0(-)]TJ
0 -1.1174 TD
[(cu)19.7(la)19.6(ri)20.7(ty)-290.3(wa)18.8(s)-300.4(c)0(o)19.7(r)0(r)20.9(e)0(l)19.5(a)0(t)19.5(e)0(d)-291.3(w)0(i)19.8(t)0(h)-290.3(m)0(a)18.4(l)0(i)20.6(g)0(n)20.8(a)0(n)19.7(c)0(y)-291.3(\()0(6)20.9(6)0(,)24.3(7)0(4)15.1(,)13.9(81)20.8(\).)-292.5(FT)19.8(C)-295.9(e)0(x)19.7(-)]TJ
0 -1.1116 TD
[(hi)20.7(bi)20.7(ts)-336.2(ot)20.7(he)19.7(r)-340.9(d)0(i)20.7(f)0(f)15.1(e)0(r)19.7(e)0(n)19.7(c)0(e)18.5(s)-340.7(in)-336.4(so)21(no)20.8(gr)20.9(ap)19.7(hi)14.9(c)-342.1(f)0(e)19.7(a)0(t)19.5(u)0(r)20.9(e)0(s)-337.2(c)0(o)19.7(m)0(p)19.6(a)0(r)19.7(e)0(d)-331.7(t)0(o)]TJ
T*
[(PT)19.8(C.)-259(Th)19.6(es)19.9(e)-267.2(t)0(u)20.7(m)0(o)19.6(r)0(s)-261.2(a)0(r)19.7(e)-267.2(mo)19.6(re)-256.8(li)20.6(ke)19.7(ly)-261.5(to)-255.7(be)-256.8(is)15.1(o-)-255.6(to)-255.8(hy)20.8(pe)19.7(re)14(ch)19.7(oi)20.7(c,)]TJ
0 -1.1174 TD
[(no)20.8(nc)19.7(al)19.5(ci)19.5(e)19.8(d,)-436.5(ro)20.9(un)20.8(d)-444.6(\()0(w)20(i)0(d)20.7(t)0(h)-434.3(g)0(r)20.9(e)0(a)18.5(t)0(e)19.6(r)-444.6(th)20.7(an)-435.3(an)19.7(te)19.5(ri)15(op)20.8(os)21(te)19.6(ri)20.7(or)-434.1(di)20.7(-)]TJ
0 -1.1116 TD
[(me)18.4(ns)21(io)20.7(n\))-163.4(no)20.8(du)20.8(le)19.5(s)-173.7(w)0(i)19.8(t)0(h)-163.6(r)0(e)19.7(g)0(u)20.8(l)0(a)19.6(r)-173.9(sm)19.8(oo)20.8(th)-163.6(ma)18.4(rg)20.9(in)20.7(s)-173.7(\()0(8)20.9(2)0(\))20.9(.)-170.5(Si)15.1(m)14.9(i)0(l)14.8(a)0(r)19.7(l)0(y)20.7(,)]TJ
T*
[(th)20.7(e)-209.6(f)0(o)20.9(l)0(l)20.6(i)0(c)19.5(u)0(l)15(a)0(r)-199.2(v)0(a)19.7(r)0(i)20.7(a)0(n)19.7(t)-208.6(of)-198(pa)13.9(pi)20.7(ll)20.6(ar)19.7(y)-208.4(c)0(a)18.5(n)0(c)19.7(e)0(r)-199.2(\()0(F)15.3(V)0(P)20.1(T)0(C)18.6(\))-208.4(is)-198(al)19.5(so)-197.8(mo)19.6(re)]TJ
0 -1.1174 TD
[(li)20.6(ke)19.7(ly)-227(th)20.7(an)-228(co)19.7(nv)20.8(en)19.7(ti)20.6(on)20.8(al)-228.1(PT)19.8(C)-238.3(t)0(o)-227(h)0(a)19.7(v)0(e)-222.2(t)0(h)14.9(i)0(s)-221(s)0(a)14.1(m)0(e)-223.5(a)0(p)19.7(p)0(e)19.7(a)0(r)14(a)0(n)19.7(c)0(e)-223.4(a)0(s)]TJ
0 -1.1116 TD
[(FT)19.8(C)-244(\()0(7)20.9(9)0(\))20.9(.)-239.6(Di)19.8(st)15.1(an)19.7(t)-237.4(m)0(e)18.4(t)0(a)19.5(s)0(t)15.1(a)0(s)19.9(e)0(s)-233.6(a)0(r)19.7(e)-244.2(ra)19.7(re)19.7(ly)-232.7(ob)20.8(se)19.9(rv)20.9(ed)-233.7(ar)19.7(is)20.9(in)14.9(g)-237.2(f)0(r)15.2(o)0(m)]TJ
T*
[(fo)20.9(ll)20.6(ic)19.6(ul)20.7(ar)-170.4(ca)18.5(nc)19.7(er)19.7(s)]TJ
/F6 1 Tf
6.9001 0 TD
(<)Tj
/F5 1 Tf
.5414 0 TD
[(2)-156.6(c)0(m)-171.6(i)0(n)-163.6(d)0(i)14.9(a)0(m)18.4(e)0(t)19.6(e)0(r)19.7(,)-176.2(wh)20(ic)19.5(h)-179.6(t)0(h)20.7(e)0(r)19.7(e)0(f)19.7(o)0(r)15.1(e)-175.1(ju)20.7(st)15.1(i)20.9(es)-170.2(a)]TJ
-7.4415 -1.1116 TD
[(hi)20.7(gh)20.8(er)-262.5(si)20.9(ze)-263.7(cu)19.7(to)20.7(ff)-261.3(fo)20.9(r)-271.8(h)0(y)20.8(p)0(e)19.7(r)0(e)19.7(c)0(h)19.7(o)0(i)20.7(c)-273(no)20.8(du)20.8(le)19.5(s)-271.6(\()0(8)20.9(3)0(\))15.1(.)]TJ
1.0137 -1.1174 TD
[(The)-241.8(vast)-247.4(majority)-241.9(\(82%91%\))-248.1(of)-244.1(thyroid)-244.1(cancers)-242.5(are)-247.5(solid)]TJ
-1.0137 -1.1116 TD
[(\(70,73,75,77,84\).)-364.4(Of)-371.7(360)-366.2(consecutively)-370.5(surgically)-370.6(removed)]TJ
T*
[(thyroid)-284.4(cancers)-294.4(at)-285.7(the)-286.8(Mayo)-288.7(clinic,)-289.2(88%)-286.6(were)-289.8(solid)-287.8(or)-284.4(mini-)]TJ
0 -1.1174 TD
[(mally)-209.7(cystic)-210.6(\()]TJ
/F6 1 Tf
5.3853 0 TD
(<)Tj
/F5 1 Tf
.5529 0 TD
[(5%\),)-209.4(9%)-204.9(were)]TJ
/F6 1 Tf
5.8231 0 TD
(<)Tj
/F5 1 Tf
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[(50%)-211.7(cystic,)-208.3(and)-211.8(only)-206.1(3%)-210.6(were)]TJ
-12.3085 -1.1116 TD
[(more)-219.9(than)-213(50%)-217.5(cystic)-222.1(\(85\).)-220.9(Therefore,)-219.5(FNA)-218(decision-making)]TJ
T*
.0119 Tc
[(f)11.9(o)11.9(r)-406(p)5(a)-1.9(r)5.1(tiall)4.9(y)-415.4(c)-1.9(y)5(s)-.5(ti)4.9(c)-416.6(t)-.8(h)5(yro)5(id)-415.4(n)5(o)-.7(d)5(u)-.7(les)-415.2(m)3.8(ust)-415.5(b)5(e)-416.6(t)-.8(emp)5(e)-1.9(r)5.1(e)-1.9(d)-415.4(b)5(y)]TJ
0 -1.1174 TD
.0114 Tc
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0 -1.1116 TD
.0126 Tc
[(s)5.9(ono)5.7(gr)5.8(aph)5.7(i)-.1(c)-352.5(f)5.8(eatur)5.8(e)-1.2(s)-351.2(w)-.9(i)5.6(t)-.1(h)-351.4(m)4.5(al)5.6(ign)5.7(a)-1.2(n)5.7(c)-1.2(y)-351.4(i)5.6(n)-357.1(t)5.6(hi)5.6(s)-356.9(s)5.9(ub)5.7(gro)5.7(up)-351.4(o)5.7(f)]TJ
T*
.0121 Tc
[(n)5.2(odu)5.2(les)-432.3(i)-.6(s)-432.3(l)5.1(es)5.4(s)-432.3(rob)5.2(us)5.4(t,)-429.1(ori)5.1(gi)5.1(natin)5.2(g)-432.5(f)-.5(r)5.3(o)-.5(m)-433.7(u)5.2(ni)5.1(variate)-433.7(r)5.3(at)5.1(her)]TJ
0 -1.1174 TD
.0118 Tc
[(t)4.8(h)-.8(an)-450.1(mu)4.9(lti)4.8(variate)-451.2(a)3.8(naly)4.9(ses)5.1(.)-452.4(Ho)]TJ
13.0861 0 TD
.0113 Tc
[(wever,)-452.9(an)-450.6(eccent)4.3(ric)-451.7(r)4.5(at)4.3(her)]TJ
-13.0861 -1.1116 TD
.0072 Tc
[(th)-5.4(an)-345.2(c)-6.6(o).3(n)-5.4(c)-6.6(en)-5.4(tr)-5.4(ic)-346.4(p)-5.4(o).3(s)-5.2(i)-5.5(ti)-5.5(on)-345.2(o)-5.4(f)-345.2(th)-5.4(e)-346.4(s).5(o)-5.4(l)-5.5(id)-345.2(c)-6.6(o).3(m)-6.6(p).3(o)-5.4(n).3(e)-6.6(n).3(t)-345.4(a)-6.6(lo)-5.4(ng)-345.2(t)-5.5(h).3(e)]TJ
T*
0 Tc
[(cy)19.7(st)-347.7(wa)18.8(ll)20.6(,)-360.5(a)0(n)-348.9(a)0(c)18.5(u)0(t)20.7(e)-359.4(ra)19.7(th)20.7(er)-348.9(th)20.7(an)-348.9(ob)20.8(tu)15(se)-348.8(an)19.7(gl)20.7(e)-359.4(i)0(n)20.7(t)0(e)19.6(r)0(f)20.9(a)0(c)18.5(e)-359.4(of)-347.8(th)14.9(e)]TJ
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BT
/F7 1 Tf
9.845 0 0 9.845 59.7543 370.5448 Tm
[(FIG.)-463.4(1.)]TJ
/F5 1 Tf
4.244 0 TD
[(Algorithm)-460.6(for)-463.7(evaluation)-463.1(and)-459.1(management)-466.2(of)-456.9(patients)-465.5(with)-460.1(thyroid)-462.2(nodules)-463(based)-462(on)-456.9(US)-463.3(pattern)-458.8(and)-464.8(FNA)]TJ
-4.244 -1.0135 TD
[(cytology.)-335.3(R,)-333.6(recommendation)-337.9(in)-336.2(text.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ATA)-340.1(THYROID)-334.7(NODULE/DTC)-339.7(GUIDELINES)]TJ
53.5677 0 TD
(13)Tj
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