Variation and potential overuse in thyroid ultrasound ordering: exploratory insights from a clinician survey

Increasing use of thyroid ultrasound has contributed to the overdiagnosis of low-risk thyroid cancer which has in turn led to overtreatment as well. Despite established guidelines, deviations from evidence-based use persist. We evaluated clinician-reported practices, knowledge, and perceptions regarding thyroid ultrasound ordering.

We conducted a pilot, exploratory, cross-sectional survey of clinicians at the University of Maryland Medical System. A 21-item electronic questionnaire assessed guideline familiarity, ordering practices, and perceived drivers of thyroid ultrasound use. The survey was distributed to internal medicine, family medicine, and endocrinology trainees, advanced practice providers, and faculty.

Thirty clinicians responded (43% internal medicine (IM), 40% endocrinology, 13% family medicine (FM), 3% IM and FM). One-third reported ordering 1-5 thyroid ultrasounds annually, while 20% reported ordering more than 50. Although 50% believed diagnostic testing improves outcomes, 47% perceived thyroid ultrasound as overused. Ordering was most driven by physical exam findings, compressive symptoms, and incidental nodules, rather than demographic factors or screening. Familiarity with American Thyroid Association guidelines exceeded that of American College of Radiology guidelines. Only 62% reported confidence in their own knowledge regarding thyroid ultrasound ordering.

Clinicians recognize potential overuse of thyroid ultrasound, driven by multi-factorial influences. Gaps in familiarity and confidence may contribute to practice variation, highlighting opportunities for targeted interventions to promote high-value care.