{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:03:18Z","timestamp":1784350998978,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Optimal management of indeterminate nodules remains a controversial area of endocrine surgery. The purpose of this study is to compare observation, molecular testing, and immediate thyroid surgery for the management of Bethesda Classes III and IV nodules in patients age 50 to 90 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A decision analysis was performed from April 22, 2021, to September 29, 2023, using a Markov model constructed with TreeAgePro 2023. Model variables and ranges were selected based on literature review data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>TreeAgePro.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 1\u2010way sensitivity analysis was performed to evaluate the age threshold at which each management pathway, immediate thyroid surgery, additional molecular testing, or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis was performed 5 times with model patients assigned starting ages of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would impact model results. Outcomes were measured with quality\u2010adjusted life\u2010years and accounted for perioperative complications including permanent recurrent laryngeal nerve injury, permanent hypoparathyroidism, and medical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the study models, molecular testing was more beneficial than surgery and observation across all ages. The age threshold at which observation became more beneficial than surgery as the next best option was 83.1 years. However, the clinical difference between all 3 treatment algorithms was relatively minimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Decision\u2010making regarding indeterminate thyroid nodules is complex. Given the clinically similar results across all 3 treatment algorithm, this study reinforces that treatment modalities should be individually tailored and based on shared physician\u2010patient decision making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.958","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T05:21:24Z","timestamp":1724736084000},"page":"1349-1354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Management of Indeterminate Thyroid Nodules: A Model Comparing Surgery, Molecular Testing, and Observation"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0158-3995","authenticated-orcid":false,"given":"Alexandra","family":"Welschmeyer","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University Hospitals Cleveland Medical Center Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Kligerman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Noel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.5935"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00044"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21578"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2015.04.059"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.614089"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0367"},{"key":"e_1_2_8_8_1","unstructured":"Survival rates for thyroid cancer. American Cancer Society.2023. Accessed September 29 https:\/\/www.cancer.org\/cancer\/types\/thyroid-cancer\/detection-diagnosis-staging\/survival-rates.html"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-019-0387-y"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0104"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489419885403"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(94)90321-2"},{"issue":"7","key":"e_1_2_8_13_1","first-page":"1","article-title":"United States life tables, 2010","volume":"63","author":"Arias E","year":"2014","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_8_14_1","unstructured":"HowieL. QuickStats: Death Rate* From Complications of Medical and Surgical Care Among Adults Aged \u226545 Years by Age Group\u2014United States 1999\u20132009. CDC.2012. Accessed June 5 2021.https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6137a6.htm"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0317"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1153"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.4616"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP-2019-0049"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2011.08.016"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2018.0779"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s44178-022-00017-6"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.2944"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14128"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28216"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-020-02676-2"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-017-0510-8"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.958","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.958","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.958","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T12:25:07Z","timestamp":1772972707000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,27]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1002\/ohn.958"],"URL":"https:\/\/doi.org\/10.1002\/ohn.958","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,27]]},"assertion":[{"value":"2023-10-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}