Background: Thyroid cancer commonly presents as a new palpable thyroid nodule or increase in size of a pre-existing nodule. A multidisciplinary thyroid lump clinic was established in September 2008 enabling patients to have one-stop clinical, biochemical, radiological and cytological assessment for evaluation of thyroid nodules. This audit predates this period, aiming to provide background information for future audit.
Aim: To evaluate the requests for thyroid ultrasound (TUS) and fine needle aspiration (FNA) between August 2007 and February 2008. TUS should be the initial investigation for biochemically euthyroid or hypothyroid patients with a palpable nodule.
Methods: A list of all TUS performed in the above period were obtained. Requests were assessed by referral source -General practice (GP), medical, surgical. Biochemistry, histology and radiology details were obtained from the hospital computer database.
Results: A total of 154 patient referrals were identified (68 GP, 60 medical, 26 surgical). Thirty-eight percent of referrals from GPs were for palpable nodules. Forty-six percent of GP referrals were not for nodules. Assessment revealed 60% of these were for goitres and 20% for abnormal thyroid function tests (TFTs). Forty-two percent of medical requests were for nodules, goitres (27%), abnormal TFTs (27%), voice change (3%), dyphagia (1%). Seventy-seven percent of surgical requests were for nodules. Of the indications aside from nodules, 80% were for goitres and 20% for abnormal TFTs. Of all FNAs performed 17 had a clinically palpable nodule and 7 had nodules identified only on TUS. One patient had a thyroidectomy for a malignancy based on a clinically palpable nodule, normal TFTs and cytology positive for cancer.
Conclusion: We can conclude that both in primary and secondary care a large number of referrals for TUS have been made for indications other than nodules. Of the 154 scans done only 24 FNAs were performed, resulting in one thyroidectomy.