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Physician Survey Reveals Need for Clarity on Appropriate Use of Thyroid Ultrasonography

By: Celeste L. Dixon
Posted: Tuesday, September 15, 2020

The use of thyroid ultrasonography may not be supported by clinical care guidelines in about one-third of cases, according to the results of a physician survey of more than 600 otolaryngologists, surgeons, endocrinologists, and primary care physicians involved in thyroid cancer care published in JAMA Surgery. Megan R. Haymart, MD, of the University of Michigan, Ann Arbor, and colleagues learned that even in the absence of guideline-supported reasons, 32.7% said they would order a ultrasound because the patient wanted it, 22.5% would do so for a positive thyroid antibody test result, and 28.0% said they’d make the order because of abnormal thyroid function test results. The Choosing Wisely Campaign, a goal of which is to reduce unnecessary medical testing, specifically states that abnormal thyroid function test results alone do not warrant ultrasound imaging.

In interviews, the authors noted that one significant result of excessive ultrasonography is the detection of cancerous thyroid nodules that will grow slowly and may never need treatment. However, the team is hopeful their results will inspire physicians to more closely follow clinical practice guidelines, such as those from the National Comprehensive Cancer Network and the American Thyroid Association.

It’s reasonable that patients can be anxious upon hearing they have one or more thyroid nodules, and their comfort with the next step taken is important. Therefore, noted Dr. Haymart in a University of Michigan press release, “Developing decision aids could help patients understand and decide when thyroid ultrasound is appropriate and when it’s not.”

Conversely, the survey also found that the surveyed physicians consistently order thyroid or neck ultrasound views when appropriate. Almost all surveyed physicians (98.2%) order them for palpable nodules; most do so as well for a large goiter (91.8%), a nodule seen on another imaging test (88.1%), and new-onset hoarseness or compressive symptoms (65.8%).

Disclosure: The study authors’ disclosure information can be found at jamanetwork.com.

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