Use of Neck Ultrasound as Surveillance in Older Adults With Thyroid Cancer

Close to one-quarter of thyroid cancers occur in older adults (ie, aged ≥ 65). This group also has other comorbidities and higher risk of death from other causes. Data on optimal neck ultrasound use for thyroid cancer surveillance in older adults are limited.

We identified patients aged ≥ 65 years diagnosed with thyroid cancer using data from the Centers for Medicare & Medicaid Services linked to health data from University of Michigan between 2016-2021 (median follow-up 3 years, range 0-6 years). We assessed demographic characteristics, comorbidities, frequency of neck ultrasound, and cause of death.

Of the 2007 patients diagnosed with thyroid cancer, median age was 74 years (range 65-100) and 65.1% were female. Overall, 76 (3.8%) died of thyroid cancer, and 259 (12.9%) died of other causes. There were more comorbidities in the cohort who died of other causes during the study period, eg, 179 (69.1%) in the cohort who died of other causes had heart disease compared with 868 (43.3%) of those in the entire cohort. Patients who died of other causes received a mean of 1.36 neck ultrasounds (range 0-12) and the remainder of the cohort received a mean of 2.38 neck ultrasounds (range 0-26) during the study period, P < .001.

Older adults with thyroid cancer are more likely to die of causes other than thyroid cancer. To improve high-value care in older adults with thyroid cancer and high-risk of death from other causes, there is need for individualized plans for neck ultrasound use.