Background: Early diagnosis of thyroid cancer has a significant impact on outcome. However, the identification of incidental microcarcinomas potentially leads to raised anxiety and overtreatment in some cases. Ultrasound (US) guided FNA is therefore the initial investigation of choice, and NICE recommends that patients presenting clinically with a thyroid lump or swelling should be seen by a specialist within two weeks of the referral. We launched a multidisciplinary thyroid lump clinic in 2010. The aim of this clinic was to reduce unnecessary investigations, improve outcomes and to improve patients experience. All patients with a suspicious thyroid nodule were diverted to the one stop clinic. They were then reviewed jointly by an endocrinologist, ENT surgeon and specialist nurse key worker. After review of their blood results, and clinical assessment, laryngoscopy and US by a dedicated radiologist were available on the spot if indicated. US guided FNA was then performed if there was a high clinical or radiological suspicion of thyroid cancer.
Results: 116 patients seen in the first year US performed in 57% patients US guided FNA performed in 66% of those (38% of all patients) 100% US and FNA performed on same day 30% patients reassured and discharged at their first visit 51% confirmed multinodular goitre 32% single nodules 16% thyroiditis 73% euthryoid 83% thyroid antibody negative 1.2% Thy3 rate 2.4% Thyroid cancer FNA inadequacy rate (Thy1) fell from 35% to 25% after clinic was introduced.
Conclusions: We believe that this has significantly improved our service: improving accuracy, reducing unnecessary tests, and with excellent patient feedback. The low Thy3 rate is noteworthy and may reflect judicious use of TSH measurement, uptake scans, statistical anomaly or false negative assessments.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.