Published online Jul 24, 2025. doi: 10.5306/wjco.v16.i7.107495
Revised: April 21, 2025
Accepted: June 4, 2025
Published online: July 24, 2025
Processing time: 119 Days and 21 Hours
Thyroid cancer incidence is rising globally, including the Democratic Republic of Congo (DRC). Despite its increasing incidence, limited data exist on physicians’ knowledge of thyroid cancer management in the DRC.
To evaluate the knowledge levels of Congolese physicians regarding the diagnosis and treatment of thyroid nodules and cancers, and to identify existing gaps and areas for improvement.
A descriptive cross-sectional study was conducted from June to August 2024, involving 369 physicians practicing in healthcare facilities across Kinshasa, DRC. Participants were selected using a multi-stage sampling method. Data were collected via a structured questionnaire covering thyroid cancer epidemiology, diagnostic methods, treatment approaches, and prognosis. Data were analyzed using SPSS version 25, employing descriptive and inferential statistics, with a P value ≤ 0.05 being considered as statistically significant.
Overall response rate was 96.1%. Of all participants, 68% were female and 32% were male physicians. General practitioners constituted 84.8% of respondents, with an average age of 34 years. While 53.7% demonstrated adequate knowledge of hypothyroidism management post-thyroidectomy and 61.2% identified the approach for hypoparathyroidism, only 5.1% recognized the need for radiotherapy in metastatic thyroid cancer cases. Awareness of anaplastic thyroid cancer treatment was limited (6.5%), and 90.2% of physicians were unfamiliar with the surgical complications. Moderate understanding was noted in diagnostic protocols, with 44.2% correctly identifying repeat fine-needle aspiration timing in Bethesda I cases. Knowledge of molecular genetics, recurrence risks, and metastasis patterns was remarkably low.
This study highlights significant knowledge gaps among Congolese physicians regarding thyroid cancer management, especially about advanced treatment modalities and molecular genetics. Targeted educational programs and improved access to diagnostic tools are critical to bridging these deficits. Addressing these gaps can enhance the quality of thyroid cancer care and align clinical practices in the DRC with global standards.
Core Tip: Significant knowledge gaps regarding thyroid cancer management exist amongst Congolese physicians despite a marked increase in incidence of thyroid cancer. We surveyed 369 physicians in the Democratic Republic of Congo using a structured questionnaire and discovered remarkable deficits in proficiency regarding available molecular diagnostics and advanced treatment modalities. Moderate understanding was noted in certain domains. Nevertheless, only 6.5% physicians were aware of anaplastic thyroid cancer treatment algorithm, and 5.1% recognized the need for radiotherapy in metastatic cases. This study, therefore, underscores the need for implementation of actionable educational initiatives amongst physicians in the Democratic Republic of Congo to optimize thyroid cancer care.
- Citation: Bukasa-Kakamba J, Bangolo AI, Poka N, Bompongo C, Wadhwani S, Wadhwani N, Kalambayi IK, Mutombo MB, Fwelo P, Bayauli P, Menga G, Sifa A, Diazabakana C, Kingebeni G, Mulumba M, Mambu D, Bokondo RM, M’Buyamba-Kabangu JR. Bridging the deficit: Assessing knowledge gaps in thyroid cancer management amongst physicians in the Democratic Republic of Congo. World J Clin Oncol 2025; 16(7): 107495
- URL: https://www.wjgnet.com/2218-4333/full/v16/i7/107495.htm
- DOI: https://dx.doi.org/10.5306/wjco.v16.i7.107495
Thyroid cancer, though constituting approximately 1% of all cancers worldwide, has seen a notable increase in incidence over recent decades[1]. This trend has also been noted in the Democratic Republic of Congo (DRC) as thyroid cancer cases have risen significantly[1]. Nonetheless, comprehensive data on the epidemiology, management, and outcomes of thyroid nodules and cancers within the country is presently scarce. This gap underscores the need for focused research to inform and enhance clinical practices pertaining to thyroid cancer management. Effective management of thyroid nodules and cancers is contingent upon healthcare providers’ proficiency in employing current diagnostic and therapeutic protocols. In many African nations, including the DRC, the availability and implementation of standardized guidelines for thyroid disease management are inconsistent[2]. This inconsistency can lead to variations in patient care and outcomes, highlighting the critical need for evaluating and bolstering physicians’ knowledge in this domain.
Previous studies in regions such as the Middle East and Africa have identified disparities in clinical practice patterns concerning thyroid nodule management[3,4]. However, specific data pertaining to Congolese physicians’ approaches remain scarce. Understanding these practices is essential, given the unique healthcare challenges and resource constraints in the DRC. Such insights can guide the development of tailored interventions to improve diagnostic accuracy and treatment efficacy. A descriptive cross-sectional study was conducted between June and August 2024 to assess the knowledge levels of Congolese physicians regarding the management of thyroid nodules and cancers. This study aimed to identify existing knowledge gaps, evaluate adherence to established clinical guidelines, and determine the need for targeted educational initiatives within the medical community. Through our study findings, we anticipate to provide a foundational understanding of current clinical practices in the DRC. By elucidating areas requiring improvement, the study seeks to inform policy decisions and educational programs, ultimately striving to enhance patient outcomes in thyroid disease management across the nation.
This was a descriptive cross-sectional study designed to evaluate the knowledge level of Congolese physicians on the management of thyroid nodules and cancers in the DRC from June to August 2024.
Statistical units: The study population consisted of practicing physicians in healthcare facilities across the DRC.
Sample size estimation: The sample size was calculated using the formula for estimating a proportion: N = Z2 × p × (1 - p)/E2, where p = 0.5 (assumed proportion of respondents with a high level of knowledge, as this value is unknown in the DRC), Z = 1.96 (95% confidence level for a two-tailed test), E = 0.05 (margin of error). This calculation yielded a minimum sample size of 384 participants.
Sampling technique: Sampling was conducted in three stages: (1) First stage: All four districts of Kinshasa (Tshangu, Funa, Mont-Amba, and Lukunga) were purposely selected; (2) Second stage: Four healthcare facilities per district were randomly selected from a list of all facilities, considering budgetary constraints; and (3) Third stage: Available healthcare providers in the selected facilities were interviewed.
The data collection sheet included parameters related to the epidemiology of thyroid nodules and cancers, thyroid gland physiology, diagnostic methods, pathophysiology, therapeutic approaches, and prognosis. A scoring system was used to assess knowledge levels: 90-100: Very good knowledge; 70-80: Good knowledge; 50-60: Average knowledge; 30-40: Poor knowledge; 10-20: Very poor knowledge.
Data were collected using an ad hoc questionnaire. Upon survey completion, the data were directly sent to a central database managed by the principal investigator and two group members.
Collected data were entered into Epidata 3.1 and analyzed using SPSS version 25. Descriptive statistics were used to assess and present the knowledge levels of physicians across different survey items. Categorical variables were presented as relative frequencies, while quantitative variables were summarized using measures of central tendency and dispersion. mean ± SDs were reported for normally distributed variables, while medians and interquartile ranges were used for non-normally distributed variables.
Out of the 384 expected participants, 369 agreed to take part in the study, representing a response rate of 96.1%. Of all the consenting participants, 68% were female, and 32% were male physicians with an average age of 34 years. 313 participants (84.8%) were general practitioners, and 56 were specialists (15.2%), with public health being the most represented specialty. The survey conducted in the DRC highlights significant gaps in local physicians’ knowledge of thyroid cancer. Table 1 summarizes the general knowledge of respondents. While a majority of respondents correctly identified that thyroid cancer predominantly affects women (74%), there was less awareness of critical clinical aspects, such as the most common type of thyroid cancer (40.4%) and its associated risk factors (33.1%). Only about half of the participants were aware of the age group most at risk (52.6%) and the most common treatment modalities (51.2%). These subpar estimates call for rigorous training and continuing medical education (CME) services to improve the understanding of fundamental epidemiological and clinical features of thyroid cancer among healthcare providers.
| Question | Correct answer | Incorrect answer | Total |
| Most affected gender by thyroid cancer | 273 (74) | 96 (26) | 369 |
| Age group most at risk for developing thyroid cancer | 194 (52.6) | 175 (47.4) | 369 |
| Most common type of thyroid cancer | 149 (40.4) | 220 (59.6) | 369 |
| Risk factors for thyroid cancer | 122 (33.1) | 247 (66.9) | 369 |
| Most common treatment for thyroid cancer | 189 (51.2) | 180 (48.8) | 369 |
| Type of thyroid cancer associated with multiple endocrine neoplasia | 162 (43.9) | 207 (56.1) | 369 |
| Most aggressive type of thyroid cancer | 167 (45.3) | 202 (54.7) | 369 |
| Most common symptom of thyroid cancer | 244 (66.1) | 125 (33.9) | 369 |
| Factors involved in the etiology of thyroid cancer | 189 (51.2) | 180 (48.8) | 369 |
| Familial forms associated with medullary thyroid cancer | 150 (40.7) | 219 (57.3) | 369 |
| Risk posed by elevated TSH levels in the context of a thyroid nodule | 179 (48.5) | 190 (51.5) | 369 |
| Thyroid cancer associated with the use of GLP-1 analogs | 109 (29.5) | 260 (70.5) | 369 |
| Factor most associated with thyroid cancer in patients with a thyroid nodule | 160 (43.4) | 209 (56.6) | 369 |
| Link between iodine deficiency and thyroid cancer | 222 (60.2) | 147 (39.8) | 369 |
| Tumor suppressor gene P53 mutation and thyroid autoimmunity | 1 (0.3) | 368 (99.7) | 369 |
| Thyroid cancer and receptor mutations | 91 (24.7) | 278 (75.3) | 369 |
| Genetic mutations in differentiated thyroid cancers compared to anaplastic type | 259 (70.2) | 110 (29.8) | 369 |
| Histological type of thyroid cancer with the highest recurrence rate | 78 (21.1) | 291 (78.9) | 369 |
| Factors associated with an increased risk of recurrence in thyroid cancer patients | 153 (41.5) | 216 (58.5) | 369 |
| Organ most commonly affected by distant metastases in thyroid cancer | 154 (41.7) | 215 (58.3) | 369 |
| Factors associated with poor prognosis in thyroid cancer patients | 35 (9.5) | 334 (90.5) | 369 |
| Most common cause of death in thyroid cancer patients | 107 (31.1) | 262 (68.9) | 369 |
Knowledge of more specialized topics, such as the genetic and molecular basis of thyroid cancer, was particularly limited. For example, only 0.3% of respondents were aware of the relationship between the P53 gene mutation and thyroid autoimmunity, and less than a quarter (24.7%) identified the association between receptor mutations and thyroid cancer. Similarly, understanding of familial and syndromic associations, such as medullary thyroid cancer linked to multiple endocrine neoplasia syndromes, was also limited at 43.9%. This indicates a broader challenge in integrating advances in molecular oncology into clinical practice in resource-limited settings, where access to diagnostic tools and advanced therapeutics could also be constrained.
Despite aforementioned knowledge gaps, some areas showed acceptable levels of awareness. Over 66% of respondents correctly identified the most common symptom of thyroid cancer, and 60.2% recognized the role of iodine deficiency in its etiology. However, less than half were aware of factors contributing to recurrence risk (41.5%) and distant metastases (41.7%). Furthermore, only 31.1% correctly identified the most common cause of death in thyroid cancer patients, underscoring an overall need for targeted educational interventions to enhance the understanding of diagnostic, the
Table 2 summarizes respondents’ ability to work up a suspected thyroid malignancy. While most respondents correctly identified the recommended initial hormonal workup (66.1%) and tools for confirming a thyroid cancer diagnosis (69.4%), knowledge of follow-up evaluation after surgery (7%), and European Thyroid Imaging Reporting and Data System (EU-TIRADS) scoring for fine-needle aspiration (7%) was notably deficient. Similarly, only 5.4% of respondents recognized Bethesda scores that are indicative of immediate surgery. Knowledge about first-line imaging for thyroid nodules was nearly evenly split, with 49.3% answering correctly. Encouragingly, the majority of respondents demonstrated an understanding of diagnostic tools for detecting metastases or recurrence (59.6%).
| Question | Correct answer | Incorrect answer | Total |
| Initial hormonal workup in the case of a thyroid nodule | 244 (66.1) | 125 (33.9) | 369 |
| Follow-up evaluation of operated thyroid cancer | 26 (7) | 343 (93) | 369 |
| EU-TIRADS scores indicating fine-needle aspiration | 26 (7) | 343 (93) | 369 |
| Bethesda scores immediately suggesting surgery | 20 (5.4) | 349 (94.6) | 369 |
| First-line imaging for thyroid nodules | 182 (49.3) | 187 (50.7) | 369 |
| Diagnostic tools for metastases or recurrence of thyroid cancer | 220 (59.6) | 149 (40.4) | 369 |
| Confirmation of thyroid cancer diagnosis | 256 (69.4) | 113 (30.6) | 369 |
Table 3 summarizes the respondents’ ability to manage thyroid malignancy. While 53.7% of respondents demonstrated adequate knowledge in managing hypothyroidism post-thyroidectomy, and 61.2% correctly identified the approach to hypoparathyroidism, only a small subset (5.1%) was aware of the types of thyroid cancer requiring radiotherapy after surgery in the presence of metastases. Similarly, only 6.5% of participants knew the correct treatment for anaplastic thyroid cancer, underscoring a substantial lack of awareness about managing aggressive forms of the disease. Ad
| Question | Correct answer | Incorrect answer | Total |
| Time for repeat fine-needle aspiration in the case of Bethesda 1 | 163 (44.2) | 206 (55.8) | 369 |
| Complications of thyroid carcinoma surgery | 36 (9.8) | 333 (90.2) | 369 |
| Types of thyroid cancer requiring radiotherapy after surgery in the presence of metastases | 19 (5.1) | 350 (94.9) | 369 |
| Management of hypothyroidism post-thyroidectomy | 198 (53.7) | 171 (46.3) | 369 |
| Management of hypoparathyroidism post-thyroidectomy | 226 (61.2) | 143 (38.8) | 369 |
| Treatment of anaplastic thyroid cancer | 24 (6.5) | 345 (93.5) | 369 |
| Stopping levothyroxine before iodine uptake for detecting metastases | 222 (60.2) | 147 (39.8) | 369 |
| EU-TIRADS grades indicating surgery without fine-needle aspiration results | 175 (47.4) | 194 (52.6) | 369 |
| True or false: Medullary thyroid cancer is sensitive to iodine and can be treated with it | 166 (45) | 203 (55) | 369 |
| Organs most commonly affected by metastases in thyroid carcinoma | 19 (5.1) | 350 (94.9) | 369 |
The findings also highlight areas where physicians exhibited moderate understanding, such as the timing for repeat fine-needle aspiration in Bethesda 1 cases (44.2% correct), and recognizing that levothyroxine should be stopped before iodine uptake to detect metastases (60.2% correct). However, the overall knowledge of metastasis patterns was poor, with only 5.1% identifying the most commonly affected organs. Misconceptions persisted regarding EU-TIRADS grades that necessitate surgery without fine-needle aspiration results (47.4% correct) and the iodine sensitivity of medullary thyroid cancer (45% correct). These results suggest a pressing need for targeted educational initiatives to improve physicians’ competence in the management and treatment of thyroid cancer in the DRC.
A survey conducted among 369 physicians in the DRC, with a 96.1% response rate, revealed substantial gaps in knowledge about thyroid cancer. Participants, predominantly general practitioners (84.8%) with an average age of 34 years, displayed limited understanding of critical clinical and molecular aspects of thyroid cancer. While many recognized that the disease predominantly affects women (74%) and identified iodine deficiency as a risk factor (60.2%), awareness of the most common type of thyroid cancer (40.4%), its associated risk factors (33.1%), and recurrence contributors (41.5%) was insufficient. Knowledge of advanced topics, such as genetic mutations and familial syndromes like multiple endocrine neoplasia, was particularly subpar. Management practices also highlighted deficiencies, with only 6.5% aware of treatments for anaplastic thyroid cancer and 5.1% recognizing when radiotherapy is required for metastatic cases. Despite some promising awareness in hypothyroidism (53.7%) and hypoparathyroidism (61.2%) management post-thyroidectomy, a lack of understanding in follow-up evaluations, surgical complications, and EU-TIRADS scoring emphasizes the need for targeted educational initiatives to enhance diagnostic and treatment competencies for thyroid cancer in the DRC.
Significant gaps in physicians’ knowledge were also noted in domains involving recognition of the most common type of thyroid cancer and its associated risk factors. This finding aligns with global observations that, despite the increasing incidence of thyroid cancer, there remains a deficiency in comprehensive understanding among healthcare providers. For instance, the American Association of Clinical Endocrinologists and the American College of Endocrinology have emphasized the need for enhanced education on thyroid carcinoma management due to observed knowledge gaps[5]. Similarly, the European Society for Medical Oncology has noted the scarcity of randomized clinical trial data on thyroid cancer management, which may contribute to inconsistencies in clinical practice[6].
The DRC survey also highlights that only about half of the participants were aware of the age group most at risk for cancer and the most common modalities available for treatment. This is concerning, as standardized management guidelines, such as those provided by the American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons, are designed to assist physicians in weighing the benefits and risks of available diagnostic and therapeutic options[5]. The lack of adherence to such guidelines in the DRC underscores the need for development of targeted educational initiatives aimed at bettering the understanding of fundamental thyroid cancer related concepts amongst healthcare providers. Addressing these knowledge gaps is crucial for the effective management of thyroid cancer, particularly in regions with limited resources. Awareness regarding the genetic and molecular underpinnings of thyroid cancer was limited; only 0.3% recognized the link between P53 gene mutations and thyroid autoimmunity, and 24.7% identified receptor mutations that are implicated in the etiopathogenesis of thyroid ma
Furthermore, the study revealed that only 43.9% of respondents were aware of the association between medullary thyroid cancer and multiple endocrine neoplasia syndromes. This is concerning, as comprehension of familial syndromes is crucial for timely detection of malignancies. Since resource-abundant regions have superior patient outcomes owing to the presence of established protocols for genetic counseling and thyroid cancer testing, educational measures need to be implemented in resource-scarce settings to improve genetic literacy and facilitate delivery of optimal medical care to these patients[10,11].
Despite these gaps, there were areas of moderate awareness; 66.1% of physicians correctly identified the most common symptom of thyroid cancer, and 60.2% recognized iodine deficiency as a significant etiological factor. Iodine deficiency is a well-established risk factor for thyroid disorders, including cancer[12-16]. However, less than half of the respondents were knowledgeable about factors contributing to recurrence risk (41.5%) and distant metastases (41.7%), indicating a need for comprehensive education on disease progression and management.
The survey results indicate that while a majority of respondents correctly identified the importance of initial hormonal workup (66.1%) and tools for confirming a thyroid cancer diagnosis (69.4%), there were notable deficiencies in knowledge regarding follow-up evaluations after surgery (7%) and the application of the EU-TIRADS for fine-needle aspiration (7%). These findings align with existing literature, which emphasizes the critical role of structured reporting systems like EU-TIRADS and the Bethesda system in standardizing the assessment and management of thyroid nodules. Studies have demonstrated a significant correlation between TIRADS classifications and Bethesda cytopathological results, underscoring the importance of familiarity with these systems for accurate diagnosis and treatment planning[17-19]. The low awareness of EU-TIRADS among respondents suggests a pressing need for targeted educational initiatives to bridge this knowledge gap.
Furthermore, only 5.4% of respondents recognized Bethesda scores that immediately indicate surgery, and knowledge about first-line imaging for thyroid nodules was nearly evenly split, with 49.3% answering correctly. Encouragingly, a majority demonstrated an understanding of diagnostic tools for detecting metastasis or recurrence (59.6%). These observations are consistent with studies highlighting the effectiveness of the Bethesda system in guiding clinical management of thyroid nodules[20-23]. The mixed responses regarding first-line imaging reflect ongoing discussions in the literature about optimal imaging modalities and follow-up protocols post-thyroidectomy[24]. Collectively, these findings emphasize the necessity for comprehensive training programs to enhance physicians’ proficiency in utilizing standardized classification systems and imaging techniques, thereby improving patient outcomes in thyroid cancer management.
The observed deficiencies in Congolese physicians’ knowledge regarding the management of thyroid cancer, particularly in recognizing indications for postoperative radiotherapy in metastatic cases (5.1%) and appropriate treatment protocols for anaplastic thyroid cancer (6.5%), are consistent with challenges reported in other low- and middle-income countries. A study by Penna et al[25] highlighted the complexities in treating radioiodine-refractory thyroid cancer in developing regions, emphasizing the need for comprehensive education and resource allocation to manage aggressive thyroid malignancies effectively. The limited awareness of surgical complications associated with thyroid carcinoma among 90.2% of respondents underscores a critical gap in surgical training. This finding aligns with the African Head and Neck Society’s guidelines, which advocate for the integration of modern, cost-effective techniques to enhance thyroid disorder management in developing countries[26]. Implementing such guidelines could mitigate surgical risks and improve patient outcomes.
Moderate understanding in areas such as the timing for repeat fine-needle aspiration in Bethesda I cases (44.2% correct) and the cessation of levothyroxine before iodine uptake studies (60.2% correct) reflects a broader issue of inconsistent guideline adherence. The overall poor knowledge of metastasis patterns, with only 5.1% correctly identifying commonly affected organs, and misconceptions about the iodine sensitivity of medullary thyroid cancer (45% correct), are concerning. The European Society for Medical Oncology has noted that the scarcity of randomized clinical trial data on thyroid cancer management contributes to variability in clinical practices, underscoring the necessity for standardized protocols to guide physicians[27].
The study’s strengths lie in its comprehensive approach to evaluating the knowledge of Congolese physicians on thyroid cancer management, utilizing a robust sample size with a high response rate of 96.1%. The inclusion of physicians from both general practice and specialized fields enables broad representation of the medical community, capturing diverse perspectives and practices. Furthermore, the use of a structured questionnaire and validated data analysis tools (Epidata 3.1 and SPSS version 25) enhances the accuracy and reliability of findings. The study’s focus on specific knowledge areas, such as surgical complications, molecular understanding, and guideline adherence, provides actionable insights to inform targeted educational interventions. However, there are notable limitations. The study’s cross-sectional design limits its ability to establish causality or assess changes in knowledge over time. The reliance on self-reported data, combined with the absence of objective measures to corroborate knowledge, may have introduced reporting bias, as respondents might have overestimated their level of knowledge. Furthermore, the exclusive sampling of patients in an urban setting may restrict the generalizability of our results. The geographical focus on Kinshasa may not fully represent the knowledge levels of physicians in rural or underserved areas of the DRC, where healthcare resources and training opportunities differ significantly. Future research should include populations from rural and semi urban areas to ensure broader representation of nationwide trends.
The overall findings underscore a pressing need for targeted educational interventions to enhance the understanding of thyroid cancer’s molecular genetics, familial associations, and progression among physicians in the DRC. We believe that the universal incorporation of thyroid cancer management modules into the training curriculum could enhance physicians’ knowledge of thyroid disorders. Trainees should be offered opportunities to participate in CME programs tailored to reflect national trends in thyroid cancer epidemiology and management. Online courses, containing synoptic overviews on relevant topics in the form of case studies, interactive videos, clinical briefings, quizzes, and coupled with in-person workshops would provide a conducive framework for training physicians on this subject matter. Training programs should consider harnessing the power of social media as a tool for professional development, peer learning, and physician education. Social media platforms can help facilitate interactive case discussions and peer-based learning. Access to accredited CME platforms dedicated to thyroid cancer management. Implementing CME programs and enhancing access to diagnostic tools could help bridge existing knowledge gaps, ultimately contributing to improved patient outcomes. Such initiatives are essential for aligning clinical practices in the DRC with global standards in thyroid cancer management.
In conclusion, this study highlights significant gaps in the knowledge of Congolese physicians regarding the management of thyroid nodules and cancers, particularly in areas involving advanced treatment strategies, molecular genetics, and surgical complications. Despite these gaps, moderate awareness was noted in basic diagnostic protocols and some aspects of disease etiology. The findings underscore an urgent need for development of targeted educational initiatives and continuous medical education activities to bridge these knowledge deficits. Enhancing access to up-to-date diagnostic tools and integrating evidence-based guidelines into practice can improve diagnostic accuracy, treatment planning, and overall patient outcomes. By addressing these challenges, the DRC has the potential to align its clinical practices with global standards and ensure better care for thyroid cancer patients within the country.
| 1. | Shank JB, Are C, Wenos CD. Thyroid Cancer: Global Burden and Trends. Indian J Surg Oncol. 2022;13:40-45. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 23] [Reference Citation Analysis (0)] |
| 2. | Zafereo M, Yu J, Onakoya PA, Aswani J, Baidoo K, Bogale M, Cairncross L, Cordes S, Daniel A, Diom E, Maurice ME, Mohammed GM, Biadgelign MG, Koné FI, Itiere A, Koch W, Konney A, Kundiona I, Macharia C, Mashamba V, Moore MG, Mugabo RM, Noah P, Omutsani M, Orloff LA, Otiti J, Randolph GW, Sebelik M, Todsen T, Twier K, Fagan JJ. African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings. Head Neck. 2020;42:167-174. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 5] [Cited by in RCA: 13] [Article Influence: 2.6] [Reference Citation Analysis (0)] |
| 3. | Beshyah S, Khalil A. Clinical practice patterns in the management of thyroid nodules: The first survey from the Middle East and Africa. J Diabetes Endocr Pract. 2021;4:167-174. [DOI] [Full Text] |
| 4. | Bukasa JK, Bayauli-Mwasa P, Mbunga BK, Bangolo A, Kavula W, Mukaya J, Bindingija J, M'Buyamba-Kabangu JR. The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19:16203. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 5] [Cited by in RCA: 4] [Article Influence: 1.3] [Reference Citation Analysis (0)] |
| 5. | Cobin RH, Gharib H, Bergman DA, Clark OH, Cooper DS, Daniels GH, Dickey RA, Duick DS, Garber JR, Hay ID, Kukora JS, Lando HM, Schorr AB, Zeiger MA; Thyroid Carcinoma Task Force. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. American College of Endocrinology. Endocr Pract. 2001;7:202-220. [PubMed] |
| 6. | Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, Papotti MG, Berruti A; ESMO Guidelines Committee. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019;30:1856-1883. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 538] [Cited by in RCA: 690] [Article Influence: 115.0] [Reference Citation Analysis (0)] |
| 7. | Schmidbauer B, Menhart K, Hellwig D, Grosse J. Differentiated Thyroid Cancer-Treatment: State of the Art. Int J Mol Sci. 2017;18:1292. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 64] [Cited by in RCA: 111] [Article Influence: 13.9] [Reference Citation Analysis (0)] |
| 8. | Carneiro HC, de Andrade Natal R, Farias EC, Bastos AA, Guastapaglia L, Bezerra AMPS, de Oliveira Hoff AAF. Predictive biomarkers in thyroid cancer in the current molecular-morphology paradigm. Surg Exp Pathol. 2024;7:14. [DOI] [Full Text] |
| 9. | Kalarani IB, Sivamani G, Veerabathiran R. Identification of crucial genes involved in thyroid cancer development. J Egypt Natl Canc Inst. 2023;35:15. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 8] [Cited by in RCA: 7] [Article Influence: 3.5] [Reference Citation Analysis (0)] |
| 10. | Richards ML. Familial syndromes associated with thyroid cancer in the era of personalized medicine. Thyroid. 2010;20:707-713. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 62] [Cited by in RCA: 47] [Article Influence: 3.1] [Reference Citation Analysis (0)] |
| 11. | Quayle FJ, Moley JF. Medullary thyroid carcinoma: including MEN 2A and MEN 2B syndromes. J Surg Oncol. 2005;89:122-129. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 55] [Cited by in RCA: 48] [Article Influence: 2.4] [Reference Citation Analysis (0)] |
| 12. | Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015;3:286-295. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 414] [Cited by in RCA: 474] [Article Influence: 47.4] [Reference Citation Analysis (0)] |
| 13. | Mitro SD, Rozek LS, Vatanasapt P, Suwanrungruang K, Chitapanarux I, Srisukho S, Sriplung H, Meza R. Iodine deficiency and thyroid cancer trends in three regions of Thailand, 1990-2009. Cancer Epidemiol. 2016;43:92-99. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 12] [Cited by in RCA: 20] [Article Influence: 2.2] [Reference Citation Analysis (0)] |
| 14. | Gyory F, Balazs G, Nagy EV, Juhasz F, Mezosi E, Szakall S, Math J, Lukacs G. Differentiated thyroid cancer and outcome in iodine deficiency. Eur J Surg Oncol. 2004;30:325-331. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 6] [Cited by in RCA: 7] [Article Influence: 0.3] [Reference Citation Analysis (0)] |
| 15. | Kim K, Cho SW, Park YJ, Lee KE, Lee DW, Park SK. Association between Iodine Intake, Thyroid Function, and Papillary Thyroid Cancer: A Case-Control Study. Endocrinol Metab (Seoul). 2021;36:790-799. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 11] [Cited by in RCA: 14] [Article Influence: 3.5] [Reference Citation Analysis (0)] |
| 16. | Zhang X, Zhang F, Li Q, Feng C, Teng W. Iodine nutrition and papillary thyroid cancer. Front Nutr. 2022;9:1022650. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 2] [Cited by in RCA: 9] [Article Influence: 3.0] [Reference Citation Analysis (0)] |
| 17. | Chatti HA, Oueslati I, Azaiez A, Marrakchi J, Boukriba S, Mizouni H, Haouet S, Besbes G, Yazidi M, Chihaoui M. Diagnostic performance of the EU TI-RADS and ACR TI-RADS scoring systems in predicting thyroid malignancy. Endocrinol Diabetes Metab. 2023;6:e434. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 4] [Reference Citation Analysis (0)] |
| 18. | Vargas-Uricoechea H, Meza-Cabrera I, Herrera-Chaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid Res. 2017;10:1. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 21] [Cited by in RCA: 25] [Article Influence: 3.1] [Reference Citation Analysis (0)] |
| 19. | Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J. 2017;6:225-237. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 573] [Cited by in RCA: 761] [Article Influence: 95.1] [Reference Citation Analysis (0)] |
| 20. | Abdullahi IM, Yasin NA, Dirken ES, Mohamoud AM, Guler I, Adani AA. Comparative study of fine needle aspiration cytology and histopathology in thyroid nodules at a tertiary care hospital: First report from Somalia. Asian J Surg. 2023;46:4202-4207. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 1] [Cited by in RCA: 4] [Article Influence: 2.0] [Reference Citation Analysis (0)] |
| 21. | Alexander EK, Doherty GM, Barletta JA. Management of thyroid nodules. Lancet Diabetes Endocrinol. 2022;10:540-548. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 7] [Cited by in RCA: 50] [Article Influence: 16.7] [Reference Citation Analysis (0)] |
| 22. | Alexander EK, Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol. 2022;10:533-539. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 10] [Cited by in RCA: 98] [Article Influence: 32.7] [Reference Citation Analysis (0)] |
| 23. | Carty SE, Ohori NP, Hilko DA, McCoy KL, French EK, Manroa P, Morariu E, Sridharan S, Seethala RR, Yip L. The Clinical Utility of Molecular Testing in the Management of Thyroid Follicular Neoplasms (Bethesda IV Nodules). Ann Surg. 2020;272:621-627. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 8] [Cited by in RCA: 32] [Article Influence: 6.4] [Reference Citation Analysis (0)] |
| 24. | Grant EG, Malhi H. The Post-Thyroidectomy US Examination: Less May Be More. Radiology. 2021;299:381-382. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 2] [Reference Citation Analysis (0)] |
| 25. | Penna GC, Rajão KMAB, Santana DC, Costa PH, Carvalho PH, Gomes GA, Avelar GA, Chaves ALF, Pitoia F. Challenges in treating radioiodine-refractory thyroid cancer: a global perspective with a focus on developing nations in Latin America. Endocrine. 2024;86:890-902. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 26. | Mallhi TH, Kanwal H, Umm-e-kalsoom, Mushtaq S, Akash MSH, Ahmad N, Khan YH, Butt MH, Khan TM, Khan A. Thyroid Disorder Management in Developing Countries. In Al-Worafi YM. Handbook of Medical and Health Sciences in Developing Countries. Switzerland: Springer, 2023: 1-23. [DOI] [Full Text] |
| 27. | Pacini F, Castagna MG, Brilli L, Pentheroudakis G; ESMO Guidelines Working Group. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23 Suppl 7:vii110-vii119. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 193] [Cited by in RCA: 184] [Article Influence: 14.2] [Reference Citation Analysis (0)] |