Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association.

The Japan Thyroid Association (JTA) recently published new guidelines for clinical management of thyroid nodules. This paper introduces their diagnostic system for reporting thyroid fine-needle aspiration cytology. There are two points where the new reporting system that differs from existing internationally-accepted ones. The first is the subclassification of the so-called indeterminate category, which is divided into 'follicular neoplasm' and 'others'. The second is the subclassification of follicular neoplasm into 'favor benign', 'borderline' and 'favor malignant'. It is characterized by self-explanatory terminologies as to histological type and probability of malignancy to establish further risk stratification as well as to facilitate communication between clinicians and cytopathologists. The different treatment strategies adopted for thyroid nodules is deeply influenced by the particular diagnostic system used for thyroid cytology. In Western countries all patients with follicular neoplasms are advised to have immediate diagnostic surgery while patients in Japan often undergo further risk stratification without immediate surgery. The JTA diagnostic system of reporting thyroid cytology is designed for further risk stratification of patients with indeterminate cytology. If a surgeon applies diagnostic lobectomy to all patients with follicular neoplasm unselectively, this subclassification of follicular neoplasm has no practical meaning and is unnecessary. Cytological risk stratification of follicular neoplasms is optional and cytopathologists can choose either a simple 6-tier system without stratification of follicular neoplasm or a complicated 8-tier system depending on their experience in thyroid cytology and clinical management.

[Method of medical treatment for Graves' disease based on evidence based medicine].

The Japan Thyroid Association has recently published the guideline for the treatment of Graves' disease with antithyroid drugs (ATD). According this guideline, "the best method of medical treatment for Graves' disease" is described here. The topics in this article include the following: the selection of ATD (Which is better, methimazole or propylthiouracil?), the suitable starting dosage of ATD (Is methimazole 15 mg daily equally effective as 30 mg daily?), the way of decreasing ATD (Is the titlation method to decrease the dosage of ATD suitable?), the duration of the ATD treatment (How long should the ATD treatment be continued?), the relation to smoking (Should smoking be prohibited for patients with Graves' disease?) and the restriction of iodine (Should patients restrict dietary iodine intake?).