Endocrine Abstracts

Referrals for thyroid or neck ultrasound from primary care are commonly made for a wide spectrum of clinical presentations, many of which result in the identification of thyroid nodule pathology which is often incidental, and unrelated to patient symptomatology. A structured guideline with clear clinical indications for thyroid ultrasound from primary care is lacking. We aimed to assess the clinical indications, relevant ultrasound findings, and subsequent referrals for specialty review or follow-up investigations from thyroid ultrasound referrals to our centre from primary care. Preliminary analysis for referrals made from January to December 2022 revealed 224 thyroid ultrasounds performed; female n = 196 (87.5%); mean age 48 years (standard deviation 15.6). Average time from referral to imaging was 2.7 months. Referrals deemed appropriate for imaging as per local policy included a palpable nodule (n = 28, 12.5%), thyroid nodule on alternative imaging (n = 16, 7.1%), surveillance of known thyroid malignancy (n = 4, 1.5%). Referrals which were not indicated included hypothyroidism (n = 30, 13.4%), hyperthyroidism (n = 13, 5.8%), non-specific local symptoms (n = 131, 58.5%), previous history of thyroid benign nodules not requiring follow-up (n = 41, 18.3%), euthyroidism with TPO positive antibodies (n = 14, 6.3%). Ultrasound findings were normal in 33 patients (13.7%), with 44 (19.6%) showing a >/=1 cm U2 and 73 (32.6%) showing a U3 nodule. There were no U4 or U5 nodules identified. One patient (0.45%) had an 8mm U3 nodule and a subsequent diagnosis of medullary thyroid cancer with a known family history of MEN2. Repeat ultrasound was performed in 29 patients (12.9%), fine-need aspiration (FNA) in 27 (12.1%), referral to subspecialty services in 83 (endocrinology n = 49 (21.9%); ENT n = 34 (15.2%)). Preliminary data suggest a large proportion of referrals from primary care for thyroid ultrasound are not clinically indicated, with an impact on subspecialty services. Clear guidelines for practitioners outlining clinical indications for ultrasound are warranted.