Endocrine Abstracts (2007) 13 P44

Should primary care have direct access to thyroid ultrasound?

Vassiliki Bravis1, Ravi Lingam1 & Devasenan Devendra2

1Central Middlesex Hospital, London, United Kingdom; 2Brent Teaching PCT, Central Middlesex Hospital & Imperial College, London, United Kingdom.

Thyroid ultrasound (US) is a useful tool in a spectrum of thyroid conditions. In some hospitals, primary care has direct access to requesting thyroid US, rather than via a speciality. We were keen to assess the outcomes of thyroid US referred by primary care.

We analysed all primary care referrals for thyroid US, retrospectively, during the first six months of 2006 and analysed them according to the following 3 reasons for referral – 1) suspicion of goitre/thyroid swelling, 2) abnormal thyroid function, 3) dysphagia.

A total of 77 subjects were referred from primary care. Mean age was 42.9 (S.D. 15.96). Out of the total number, 45 patients were referred with suspicion of goitre. The US report confirmed a multinodular goitre (MNG) in 9 subjects, solitary nodule in 11 subjects, normal thyroid gland in 24 subjects and thyroiditis in 1 subject. An US was requested in 15 subjects due to abnormal thyroid function. 6 had a MNG, 1 patient had a hypothyroid gland and 8 had a normal US. Dysphagia was the reason for referral in 17 remaining subjects. The cause for the dysphagia was identified on US in 5 patients (3 MNG, 1 MNG with dominant nodule, 1 thyroiditis), whereas the rest had to have further imaging. Among the 77 subjects referred by primary care, 13 underwent a thyroid fine needle aspiration (FNA). 11 had a dominant/solitary nodule and 2 MNG. FNA revealed benign disease in 8 subjects, thyroiditis in 1 subject and insufficient sample in 4 subjects. From the latter group 1 subject underwent hemithyroidectomy, which confirmed follicular adenocarcinoma on histology.

We conclude that primary care access to thyroid US has not proven of value in detecting sinister thyroid pathology. Efficiency in investigating thyroid pathology as well as rationalisation of resources may be achieved by involving secondary specialist care.

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