‘Notable’ proportion of thyroid ultrasounds are unnecessary, leading to potential overdiagnoses
A “notable” proportion of thyroid ultrasound are unnecessary, leading to potential overdiagnoses and wasteful follow-up treatments, according to new research.
The modality is key to diagnosing thyroid cancer—one of the most rapidly increasing forms of the disease in the U.S. and the most common among young adults. However, mortality rates for thyroid cancer have remained consistently low, experts note, raising concerns about overdiagnosis and detection of cancers that pose “minimal or no threat to health.”
Mayo Clinic researchers recently sought to quantify the number of unnecessary thyroid scans, sharing their findings Thursday in JAMA Otolaryngology–Head & Neck Surgery. They estimate that about 1 of every 13 such exams is unnecessary, with a few factors showing up most frequently.
“These findings highlight the need for targeted educational and system-level interventions to optimize the use of [thyroid ultrasound], which may reduce the risks of overdiagnosis and overtreatment of thyroid conditions,” lead author Felipe Larios, MD, with the Mayo Clinic’s Department of Medicine, and colleagues concluded.
For the study, researchers analyzed data from all adult patients who underwent their first thyroid ultrasound across four Mayo sites between 2017 and 2021. They excluded any individuals who previously had a thyroid nodule, cancer or surgery. Larios and colleagues then applied a natural language processing model to classify ultrasound orders as inappropriate, based on clinical guidelines.
Across over 11,000 patient cases, about 7.6% (or 866 instances) were labeled as wasteful imaging. Patients of a younger age, hyperthyroidism, scans ordered by nonendocrinology specialties (such as oncology or hematology), and orders not linked to an in-person appointment all were “strongly” associated with unnecessary ultrasounds. Compared to appropriately ordered imaging, wasteful scans led to lower rates of thyroid nodule detection (23% vs. 65%), biopsies (10% vs. 25%), partial thyroidectomies (2% vs. 4%), and confirmed cancer cases (2% vs. 4%).
From their findings, the authors suggested three strategies to address unnecessary thyroid imaging orders:
- Education: Initial efforts could focus on developing “intensive, specialty-specific” educational programs for clinicians outside of endocrinology. They could emphasize the appropriate evaluation of thyroid dysfunction, with the study unearthing high odds of inappropriate imaging when guideline criteria were not met.
- CDS: Healthcare institutions could simultaneously look to implement “robust” clinical decision support tools, directly integrated into EHR systems, to curb inappropriate orders. Such systems should flag requests that appear to deviate from clinical guidelines, especially for patients with thyroid dysfunction or when orders originate without a recent in-person evaluation.
- Patient materials: Inappropriate ultrasound orders also often stemmed from patient requests made via online portals. Providers could potentially respond to this by designing “clear, accessible” educational materials and standardized messages to send patients. These resources could help to manage patient expectations, clarify appropriate indications for imaging, and reduce requests.
“Further research is needed to understand the underlying reasons for these associations and to develop targeted interventions, such as enhanced healthcare professional education and improved clinical decision support tools, to promote appropriate use of [thyroid] and mitigate the risks of unnecessary procedures,” the authors concluded.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.