Endocrine Abstracts

Referrals for thyroid ultrasound (US) from primary care are made for variable clinical presentations resulting in the incidental identification of asymptomatic thyroid nodules. We assessed primary care thyroid US referrals and follow-up investigations between January 2022 and July 2023. 424 referrals were received, 87% female (n = 368), median age was 45 years. 20% (n = 84) were appropriate referrals as per local policy: palpable nodules (10.3%; n = 44), thyroid nodule on alternative imaging (7.1%; n = 30), surveillance of known thyroid malignancy (2.4%; n = 10). 80% (n = 340) were not indicated: hypothyroidism (10.4%; n = 44), hyperthyroidism (5.9%; n = 25), subjective neck symptoms only (37%; n = 158), known thyroid nodules previously discharged (18.6%; n = 79), euthyroidism with TPO positivity (4.2%; n = 10), patient request (0.9%; n = 4), other (4.7%; n = 20). Follow-up US was recommended by radiology in 5.9% (n = 25). Repeat US was arranged from primary care for 17 patients, 4 of which were indicated. FNA was recommended in 2.4% (n = 10), one of whom had FNA organised from primary care. 9 further patients had unnecessary FNA performed. Referral to specialty services was recommended in 6.8% (n = 29). However, 34.4% (n = 146) were referred. 7.3% (n = 31) with further investigations recommended did not have these requested in our centre. From secondary care, 17 patients (4.0%) had repeat US only; 37 (8.7%) had FNA; 5 (1.2%) had surgery, 2 of whom (0.5%) had new malignancy identified, - one with medullary thyroid cancer (family history of MEN 2), and another, papillary cancer. A considerable proportion of thyroid US referrals from primary care were not indicated, with an impact on subspecialty services. Clear guidelines for practitioners outlining clinical indications for ultrasound are warranted.