Evaluation of Palpable Thyroid Nodules:Are Endocrinologists Assessing Patients Efficiently?

摘要

One of the most common clinical problems for endocrinologists is the evaluation of thyroid nodules. Radionuclide scans and thyroid ultrasonography, traditionally used to distinguish malignant from benign nodules, are costly and provide nonspecific results. Currently, authors of clinical practice guidelines recommend fine-needle aspiration (FNA) cytology as the best initial test for evaluating thyroid nodules. This paper reviews the practice patterns of thyroid specialists and primary care providers at the Gundersen Lutheran Medical Center and summarizes the pattern of thyroid nodule evaluation published by other endocrinologists. The results indicate that FNA cytology was widely used at our institution by both thyroid specialists and primary care providers. Since the introduction of FNA cytology, the use of radionuclide scanning has decreased from 90% to 12% and the use of thyroid ultrasonography from 30% to 10%. Although the frequency of thyroid surgery fell, the detection of thyroid cancer in operative specimens increased from 16% to 43%, whereas the cost of removing a thyroid carcinoma decreased from