Endocrine Abstracts

Over the past two decades, the developed world has witnessed an epidemic of incidental thyroid nodules diagnosed through imaging of the neck for other indications. This has created new challenges for patients and clinicians. Several guidelines have been published in the past 2 years on this topic, which are broadly concordant and only differ in detail. Optimal management is based on the following principles:

1. Avoidance of imaging unless there is a clear indication

2. Clinical risk stratification based on individual patient’s characteristics

3. Ultrasound-based risk stratification

4. Progress to cytological evaluation if indicated

5. Clear communication between responsible clinician, patient and other relevant parties at all stages of the diagnostic process

09:45 – 11:15

I am not a radiologist and I don’t perform US of the thyroid. Got as far as attending an ETA workshop on thyroid US about 8 years ago and decided it was not for me, based on the fact that the environment in which I worked offered high quality thyroid US and US guided FNA that was easily accessible, which I would never match. It perplexes me that colleagues (mainly in Europe) who have been trained in thyroid US, are total converts and will use it in their clinic, not just in patients with nodules but any thyroid patient. “My clinical assessment of any patient with thyroid disease seems incomplete without the US probe”.

As for my personal experience with CT, MR and PET it is confined to what comes my way form referrals and our MDT.

Speaking of our MDT, since I was asked to produce this talk, I started to collect some data on incidentalomas and here they are.

So, I will approach this topic from the “jobbing” endocrinologist

Themes

1. Definition

2. Extent of the problem

3. Trends over time

4. What do the guidelines tell us

5. What the guidelines do not tell us (clinical vignettes)

6. Glimpse into the future

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