Open AccessBRIEF REPORT: Use and Misuse of Thyroid Ultrasound in the Initial Workup of Patients with Suspected Thyroid Problems Referred by Primary Care Physicians to an Endocrine Clinic
Author(s) -
Liel Yair,
Fraenkel Nitay
Publication year - 2005
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.0124.x
Subject(s) - medicine , thyroid , referral , pediatrics , audit , thyroid function tests , endocrine system , general surgery , hormone , family medicine , management , economics
Background and Objectives: Thyroid ultrasound (TUS) plays an important but limited role in the evaluation of some complaints related to the thyroid gland. This study was designed to examine how primary care physicians use TUS before referring patients to an endocrine clinic. Design: We audited all charts of first‐time referrals for appropriateness of TUS use. Recommendations in practice guidelines and current textbooks defined appropriate indications for TUS: (1) patients with a thyroid nodule and a history of head or neck irradiation; (2) follow‐up of patients with nodules not surgically removed; and (3) evaluation of patients with amiodarone‐induced thyrotoxicosis. Setting: Endocrine referral clinic in a teaching hospital in Israel. Results: Two hundred and eight unselected referrals were reviewed. Sixty‐nine (33%) of the patients presented with a TUS. Documented reasons for TUS were suspected thyroid mass ( n =35, 51%), thyroid dysfunction ( n =21, 30%), neck pain ( n =5, 7%), dyspnea ( n =4, 6%), and dysphagia ( n =2, 3%). Of the 69 TUS reviewed, 64 (93%) were not appropriate. Conclusions: Primary care clinicians obtain TUS studies in patients without recommended indications prior to referral to an endocrinologist.