<h5><span>Current RMA Instruments</span></h5><table border="1" cellpadding="0" cellspacing="1" width="100%"><tbody><tr><td><p><a href="http://www.rma.gov.au/assets/SOP/2022/9dba89dd2d/039.pdf&quot; target="_blank"><em><u>Reasonable Hypothesis SOP</u></em></a></p></td><td><p>39 of 2022</p></td></tr><tr><td><p><a href="http://www.rma.gov.au/assets/SOP/2022/a8a13294b0/040.pdf&quot; target="_blank"><em><u>Balance of Probabilities SOP</u></em></a></p></td><td><p>40 of 2022</p></td></tr></tbody></table><h5><strong>Changes from previous Instruments</strong></h5><p><drupal-media data-entity-type="media" data-entity-uuid="7aeedf0d-9441-4644-909c-2d2c73814582" data-view-mode="wysiwyg"></drupal-media></p><h5><strong>ICD Coding</strong></h5><ul><li>ICD-9-CM Code: 193</li><li>ICD-10-AM Code: C73</li></ul><h5><strong>Brief description</strong></h5><p>This SOP covers malignant neoplasms of the follicular cells of the thyroid gland.  Medullary carcinoma, arising in the parafollicular cells of the thyroid, is excluded.</p><h5><strong>Confirming the diagnosis</strong></h5><p>This diagnosis is based on histopathology of the thyroid gland, from a (fine-needle aspiration) biopsy or surgery.</p><p>The relevant medical specialist is a general surgeon or endocrinologist.</p><h5><strong>Additional diagnoses covered by SOP</strong></h5><ul><li>anaplastic thyroid carcinoma</li><li>follicular thyroid carcinoma</li><li>Hurthle cell thyroid cancer</li><li>mixed medullary and follicular thyroid cancer</li><li>noninvasive follicular variant of papillary thyroid carcinoma (NI-FVPTC)</li><li>papillary thyroid carcinoma</li><li>thyroid neoplasms of uncertain malignant potential</li></ul><h5><strong>Conditions excluded from SOP</strong></h5><ul><li>Adenoma of thyroid^#</li><li>Carcinoid of thyroid^#</li><li>Hodgkin’s lymphoma of the thyroid*</li><li>Medullary carcinoma of the thyroid^# – this is a neoplasm arising from the parafollicular cells (also called C-cells).</li><li>Non-Hodgkin lymphoma of the thyroid*</li><li>Secondary/metastatic cancer involving the thyroid (code to primary cancer site)</li><li>Soft tissue sarcoma of the thyroid*</li><li>Thyroid hyperplasia^#</li></ul><p>* another SOP applies</p><p>^# non-SOP condition</p><h5><strong>Clinical onset</strong></h5><p>The condition usually presents with a thyroid nodule (lump) detected by the patient, by a doctor on clinical examination, or incidentally on imaging performed for another reason.</p><h5><strong>Clinical worsening</strong></h5><p>The only SOP worsening factor is for inability to obtain appropriate clinical management. Appropriate treatment typically comprises surgery, followed by radioiodine therapy (when indicated) and thyroid hormone suppression therapy.</p><p> </p>