Survey shows wide variance in management of thyroid nodules

In a web-based survey, clinicians reported taking a variety of approaches to managing thyroid nodules.

Nicole O. Vietor , MD, of Walter Reed National Military Medical Center, and colleagues conducted a web-based survey of 897 members of the American Thyroid Association, the Endocrine Society and the American Association of Clinical Endocrinologists to determine practice trends in the management of thyroid nodules.

Nearly all respondents reported that their initial evaluations include measuring thyroid-stimulating hormone (99.4%); more than half use thyroid ultrasound (52.1% in clinic; 57.2% in radiology), and only 8.4% begin with a serum calcitonin test.

More than half of participants reported they would assess cervical lymph nodes during the initial ultrasound (68.5%) whereas 4.5% said they would obtain radio-scintigram.

Fine-needle aspiration (FNA) was most commonly conducted by an endocrinologist (56.6%) followed by a radiologist (31.9%) or pathologist (6.3%). Ultrasound-guided FNA was used by 83.3% of participants, and 56.5% used some form of analgesia. Molecular analysis was used by 58.5% of participants.

Six nodules cases were presented to all participants: five low-risk and one high-risk. FNA was recommended by 93.8% of participants for the high-risk nodule, and 40.5% recommended FNA for the low-risk nodules.

More than half of participants reported they would be less likely to recommend FNA for older adults (64.2%), and 34.1% would postpone FNA until after pregnancy. Sixty-five percent of participants reported they would conduct a repeat ultrasound after benign FNA results.

Participants reported they would most likely send patients for molecular analysis of atypia of unknown significance/follicular lesion of undetermined significance (38.3%) followed by repeat FNA (31.5%) or surgery (24.4%).

Participants reported they would send more patients for a lobectomy (46.6%) compared with molecular analysis (29%) for follicular neoplasm. Total thyroidectomy (43.1%) or lobectomy (43%) were the most common referrals for suspicious FNA, and only 9.5% of participants reported they would refer patients for molecular analysis.

“In summary, management of a thyroid nodule is highly variable and differs from societal guidelines in multiple areas,” the researchers wrote. “Regional differences exist with regard to FNA, particularly the use of molecular analysis.” – by Amber Cox

Reference:

Vietor NO, et al. Oral 10. Presented at: 15th International Thyroid Congress and 85th Annual Meeting of the American Thyroid Association (ITC/ATA); Oct. 18-23, 2015; Lake Buena Vista, Fla.

Disclosure: Vietor reports no relevant financial disclosures.