One-Third of Physicians Reported Scheduling Unsupported Thyroid Tests

Nearly one-third of surveyed physicians reported ordering thyroid ultrasonography for reasons not supported by current screening guideline, according to a recent study.

To examine trends in the use of ultrasonography in screening for thyroid cancer, the researchers surveyed 162 primary care physicians, 176 endocrinologists, 130 otolaryngologists, and 134 general surgeons. Of these, 432 (69.7%) reported having read the 2015 American Thyroid Association guideline for screening of adult patients with thyroid nodules and differentiated thyroid cancer and/or the 2017 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology-Thyroid Carcinoma.

The survey asked physicians to determine whether they would schedule thyroid or neck ultrasonography in various clinical scenarios. Answers were grouped based on whether they were or were not guideline supported.

Overall, a majority of the physicians answered that they would schedule ultrasonography in scenarios that were clinically supported: palpable nodules (599 [98.2%]), large goiter (560 [91.8%]), nodule seen on another imaging test (538 [88.1%]), and new-onset hoarseness or compressive symptoms (398 [65.8%]). However, many also reported that they would schedule ultrasonography for reasons that were not guideline supported: patient request (202 [32.7%]), abnormal thyroid function test results (169 [28.0%]), positive thyroid antibody test result (136 [22.5%]), and fatigue (3 [0.5%]).

Scheduling of ultrasonography in response to patient request was more likely in endocrinologists (odds ratio [OR], 2.46 [95% CI, 1.22-4.97], otolaryngologists (OR, 2.87 [95% CI, 1.49-5.54]), and general surgeons (OR, 2.20 [95% CI, 1.19-4.06]) than in primary care physicians. Further, those who managed 10 or fewer patients with thyroid nodules per year were less likely to schedule ultrasonography based on positive thyroid antibody test than were those who saw 50 or more thyroid nodules per year.

“[T]his study highlights the need for focused physician education on clinically supported and unsupported indications for use of thyroid ultrasonography, with potential roles for future clinical practice guidelines, patient decision-making aids, and clinical decision-making support tools,” they concluded.

—Michael Potts

Reference:

Chen DW, Reyes-Gastelum D, Radhakrishnan A, et al. Physician-reported misuse of thyroid ultrasonography. Published online August 12, 2020. JAMA Surg. doi:10.1001/jamasurg.2020.2507