Table 3.

Key points for the clinician

Recommendations and suggested actions		QOE	SOR grade
Technical standards and standardization of reporting results
(R1) US examination	– High-frequency linear probe	+	1
	– Color flow or power Doppler
	– Thyroid bed (VI) and lateral compartments (II–IV, V) analysis and diagram indicating levels
	– Classification of LN
(R2) FNA	24 – 27 gauge Tg or calcitonin in situ assessment	+	1
(R3) Antiplatelet agents or oral anticoagulants	Can be maintained INR <2.5 – 3	+	1
(R4) Mass in the thyroid bed	Suspicious if hypoechoic and/or cystic component, calcifications, irregular shape, increased vascularization	+	1
(R5) Lymph node	– Normal: normal hilum, ovoid shape, absent or hilar vascularization and no suspicious feature	+++	1
	– Suspicious: cystic areas, microcalcifications, peripheral or diffusely increased vascularization, hyperechoic tissue looking like thyroid
	– Indeterminate: absence of a hilum and at least one of the following signs: round shape, increased short axis, increased central vascularization
Indications for cervical US
(R6) After total thyroidectomy, at the time of ablation
US should be performed to check the lateral compartments if:	– Cancer fortuitously discovered at histology	+	1
	– No available detailed preoperative US
	– Radioiodine activity outside the thyroid bed on post ablation scan
	– High preablation Tg value
(R7) Three months after ablation, for pT4, R1
	Reassess tumor extension or persistence with US or other imaging methods	++	1
(R8) Six to 12 months after total thyroidectomy: reassess the risk of recurrence
	US mandatory + serum Tg level (under LT4 or rhTSH stimulation)	+++	1
(R9) During follow-up (1 – 5years)
Very-low-risk and low-risk patients	If checkup at 6 months is normal, annual US is not necessary	+	2
High-risk patients	Annual cervical US is recommended, depending on pTNM staging, serum Tg level and reassessment results	+	1
(R10) After 5 years
Very-low-risk and low-risk patients	Regular US is not recommended. A final US scan combined with basal ultrasensitive serum Tg 5 – 7 years after initial treatment may be carried out	+	1
High-risk patients	– A second risk assessment 5 years postoperatively should be carried out	+	2
	– US combined with basal and/or stimulated serum Tg measurements can be continued annually depending on the results of the risk reassessment
(R11) After a lobectomy	First US recommended 6 – 12 months after surgery and should, in principle, be regular and at 2- to 3-year intervals	+	2
Indications for US-FNA and in situ biological marker assessment
(R12) Suspicious and indeterminate LNs	FNA cytology and FNA-Tg are indicated but should take into account both the stage and histology of the disease as well as the size and location of the LNs and the serum Tg level	+++	1
Small LN	<5 – 7 mm in their short axis Conservative approach	+	1
Suspicious thyroid bed lesions above 10 mm or growing	FNA is recommended	+	1