Neck Ultrasound in Older Adults With Thyroid Nodules: Considering Risk of Death From Other Causes

Thyroid nodules are common in older adults with the majority being benign. Optimal use of neck ultrasound for nodule surveillance in older adults, particularly in the setting of comorbidities and competing causes of death, remains unknown. We aimed to evaluate the use of neck ultrasound for thyroid nodule surveillance in older adults and to assess subsequent cause of death.

We used a dataset that combines the Centers for Medicare & Medicaid Services data with the health data of University of Michigan Medicine patients between 2016 and 2021. We identified patients aged ≥ 65 with thyroid nodule(s) (median follow-up 2 years, range 0-6 years). Demographic characteristics, number of comorbidities (range 0-6), frequency of neck ultrasound, and cause of death were analyzed.

Of the 18 001 patients diagnosed with thyroid nodules, median age was 75 years (range 65-105), and 71.2% were female. Only 29 (0.2%) died of thyroid cancer and 2387 (13.3%) died of other causes. Patients who died of other causes had more comorbidities (mean comorbidities 1.73, range 0-5 vs mean comorbidities in entire cohort 1.2, range 0-6). During the study period, those who died of other causes received a mean of 1.31 neck ultrasounds (range 0-12) whereas the rest of the cohort received a mean of 2.41 neck ultrasounds (range 0-26), P < .001.

Older adults with thyroid nodules are more likely to die of causes other than thyroid cancer. Neck ultrasound for surveillance should be tailored to the patient, with consideration for comorbidities and life expectancy.