Registry codes: END-THY-NOD/CAN/INC · END-PTH · converted from the registry dossier families/11-thyroid-parathyroid-expanded.md — the dossier remains the source of truth; this page is its reading surface.
28 cards · 🟢 18 verified · 🟡 7 qualified · 🔴 2 disputed · ⚪ 1 qualitative — global registry: 41 disputed cards carry their dispute on the card.
Ruda et al. SR, 2005 · 88.9% · ~10% · 4.1% · 5.7% · 0.74% · 20,225 cases pooled from published surgical series, 1995–2003, pathology-report classification
AAES Guideline, 2016 (ADOPTED) · ~85% · ~15% (reported range across series 6–33%) · (within MGD) · (within MGD) · <1% · Guideline synthesis incl. bilateral-exploration series with complete gland ascertainment
Why they differ
Difference in ascertainment: the published Ruda series mostly came from concentrated surgical centres classifying by pathology reports in an era when some multigland disease was recorded as a single adenoma; while the AAES guideline includes bilateral-exploration series in which all four glands are examined, so multiplicity appears in full.
Adopted
The AAES set (single ~85% · multiple ~15% · cancer <1%).
ADOPTED: ≈1 in 10 over 3–4 years in recent cohorts
(9% over median 4.2 y, n=73; 11.6% within 3 y, n=404) — older referral cohort 22% shown in Dispute D4
Development of frank hypercalcaemia during follow-up of normocalcaemic pHPT (raised PTH, persistently normal total + ionised calcium, secondary causes excluded)
🔴Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed
Referred cohorts under observation
Basis — n / evidence base
See D4
Evidence tier (the registry's wording)
Cohorts — 🔴 resolved
Dispute — the sources disagree
Source · Progression to hypercalcaemia · Cohort · Follow-up
Columbia experience (older referral cohort) · 22% · Referred normocalcaemic pHPT patients · ~4 y average
Turkish multicentre cohort, *Horm Metab Res*, 2026 · 11.6% · 404 patients, nationwide multicentre · within 3 y
JBMR Plus cohort, 2024 · 9% · 73 patients, tertiary centre · median 4.2 y
Why they differ
Referral intensity and baseline values: the older Columbia cohort was referral patients with higher baseline calcium (which is itself a predictor of progression in all studies), while the newer cohorts are broader and milder. The definition is roughly the same (raised PTH + persistently normal calcium after excluding secondary causes).
Adopted
≈1 in every 10 over 3–4 years (the two modern cohorts' range 9–11.6%).
⚪ reported prevalence spans purely as a function of the definition and exclusions applied (vitamin D threshold, ionised vs total calcium, medication exclusions)
END-THY-CAN-AS-01 · Tumour enlargement under active surveillance
🟢Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed
Low-risk PTMC (T1aN0M0), Kuma Hospital AS programme
Basis — n / evidence base
3,222 AS patients (of 5,646 total, 1993–2019)
Evidence tier (the registry's wording)
Prospective-programme cohort, 30-y experience
Dispute — the sources disagree
Source · Cohort · Enlargement ≥3 mm @10 y · Novel nodal metastasis @10 y · Follow-up basis
Ito et al., *World J Surg*, 2010 · 340 AS patients (1993–2004 era) · 15.9% · 3.4% · Mean ~74 months, KM to 10 y
Ito et al., *Thyroid*, 2014 · 1,235 AS patients · 8.0% · 3.8% · KM to 10 y
Miyauchi et al., *Thyroid*, 2023 (ADOPTED) · 3,222 AS patients (programme 1993–2019) · 4.7% · 1.0% · KM to 10 and 20 y (6.6% / 1.6% @20 y)
Why they differ
Same centre and same definitions (≥3 mm; new nodules) — what changed is the cohort size and the maturity of patient selection: the early small cohorts showed higher rates (unstable Kaplan–Meier tails + learning-era selection), and the larger the cohort and the more regular the 'truly low-risk' criteria, the lower the rates fell. It is not a disagreement of definition or technique.
Adopted
Miyauchi 2023 — the largest cohort (3,222 under surveillance), the longest follow-up (to 20 years), and the newest analysis of the whole programme.
END-THY-CAN-AS-02 · Novel nodal metastasis under AS; hard endpoints
🟢Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed
Same cohort
Basis — n / evidence base
5,646 patients
Evidence tier (the registry's wording)
Same
Dispute — the sources disagree
Source · Cohort · Enlargement ≥3 mm @10 y · Novel nodal metastasis @10 y · Follow-up basis
Ito et al., *World J Surg*, 2010 · 340 AS patients (1993–2004 era) · 15.9% · 3.4% · Mean ~74 months, KM to 10 y
Ito et al., *Thyroid*, 2014 · 1,235 AS patients · 8.0% · 3.8% · KM to 10 y
Miyauchi et al., *Thyroid*, 2023 (ADOPTED) · 3,222 AS patients (programme 1993–2019) · 4.7% · 1.0% · KM to 10 and 20 y (6.6% / 1.6% @20 y)
Why they differ
Same centre and same definitions (≥3 mm; new nodules) — what changed is the cohort size and the maturity of patient selection: the early small cohorts showed higher rates (unstable Kaplan–Meier tails + learning-era selection), and the larger the cohort and the more regular the 'truly low-risk' criteria, the lower the rates fell. It is not a disagreement of definition or technique.
Adopted
Miyauchi 2023 — the largest cohort (3,222 under surveillance), the longest follow-up (to 20 years), and the newest analysis of the whole programme.
Era and reclassification: iodine sufficiency historically reduced the follicular share, and the follicular variant of papillary carcinoma is counted as papillary in modern classifications. The trend is visible even inside SEER itself between the two windows (follicular 5.5% ← 4.6%).
Adopted
SEER 2010–2014, with its years named wherever it is mentioned.
Sources
NCI SEER Cancer Statistics Review, histology distribution table (SEER 18, 2010–2014) — official registry table opened 2026-11-06
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 11 (11-thyroid-parathyroid-expanded.md), coded unit; registry audit 2026-11-06. Permalink to this card
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END-THY-INC-01 · ACR workup thresholds for incidental thyroid nodules (ITN)
age <35 y and nodule ≥1 cm · age ≥35 y and nodule ≥1.5 cm · no further evaluation
Further evaluation with dedicated thyroid US if: , or · Suspicious imaging features (invasion, pathological nodes) → US regardless of size/age · Limited life expectancy or serious comorbidity →
ITN on CT, MRI, or extrathyroidal US, without suspicious features and with normal life expectancy
Reported on up to examinations (and up to ~25% of chest CT in the white paper's cited data) — i.e., an everyday radiology event, most of which the thresholds in INC-01 deliberately leave alone
ITN reported on cross-sectional neck/chest imaging
END-THY-NOD-BET-01 · Bethesda System 2023 — implied risk of malignancy by category (I–VI)
13% (5–20)
Category I — Nondiagnostic · usual management: repeat FNA under US guidance
2023 edition — the risks are computed counting NIFTP as not malignant. Category I is the headline value; categories II–VI are in variants (one coded unit spanning the whole table, as the dossier prints it).
~50% in classic fine-slice (2–3 mm serial section) series vs pooled (95% CI 4.8–8.5) in the autopsy subgroup of the 2022 global MA, whose studies largely used macroscopic examination
🟡Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed
Adults without known thyroid disease
Basis — n / evidence base
See Dispute D5
Evidence tier (the registry's wording)
SR/MA subgroup + historical series
Dispute — the sources disagree
Serial fine slicing (2–3 mm) of the whole gland · ~50% of glands harbour ≥1 nodule · Classic autopsy series, as summarised in opened reviews
Macroscopic examination (pooled modern subgroup) · 6.4% (95% CI 4.8–8.5) · Mu et al. 2022 SR/MA, autopsy subgroup (10 studies)
Adopted
Why do they differ? Slice thickness is the figure: fine slicing finds millimetric nodules that macroscopic examination does not see at all — two bounds of two different methods, and no error in either.
🟢Verified. Confirmed in 2+ independent sources, full text opened
Variants the registry prints
FNA threshold: TR3 ≥2.5 cm · TR4 ≥1.5 cm · TR5 ≥1.0 cm
Basis — n / evidence base
Multi-institutional dataset, 3,422 nodules (352 malignant), Middleton et al., *AJR* 2017 — the dataset from which the ACR white paper's published risks derive; values verified in two independent opened full texts