Compliance with guidelines for thyroid nodule evaluation

To determine whether guidelines recommended by the American Association of Clinical Endocrinologists (AACE) for assessment of a solitary thyroid nodule have been applied in clinical practice.

We retrospectively examined the pattern of testing in patients with solitary thyroid nodules at our institution during a 2-year period. We also attempted to determine whether consultation with an endocrinologist affected the workup. Patients who underwent a thyroid scan, ultrasonography, fine-needle aspiration (FNA) biopsy, or a thyroid surgical procedure for investigation of a solitary thyroid nodule between Jan. 1, 1996, and Dec. 31, 1997, were included in the study. Test results were reviewed for these patients. Patients were categorized into two groups, those with and those without a consultation with an endocrinologist.

Inclusion criteria were met by 89 patients, 65% of whom had an FNA biopsy in their evaluation (the sole test in only 9%). A thyroid scan was done in 90% of patients, and an ultrasound study was done in 25%. Patients seen by an endocrinologist were more likely to undergo FNA biopsy than those who were not (82% versus 29%; P<0.001). Many patients who underwent assessment because of solitary nodules had normal findings on thyroid scans (21% of scans).

The AACE guidelines for evaluation of thyroid nodules have not yet been fully implemented. Although a third of all study patients with a solitary thyroid nodule did not have an FNA biopsy, endocrine referral increased the rate of performance of this procedure. Thyroid scans seem to be overutilized; the high number with normal findings suggests that nuclear imaging studies are done to confirm physical findings. Early referral to an endocrinologist may be a more cost-effective workup of a possible thyroid nodule.