Adherence to Guideline Recommendations in Patients with Thyroid Nodules

Abstract

Introduction. Thyroid nodules are common and fine-needle
aspiration (FNA) biopsy is the standard of care for workup
to exclude thyroid cancer. In this study, we examined
the discrepancy between daily practice and recommended
diagnostic approach for management of thyroid nodules,
based on history taking, laboratory, and imaging studies.

Methods. This was a retrospective chart review of 199 patients
who had ultrasound-guided fine needle aspiration
(UGFNA) performed at a Midwest academic medical
center from January 2010 to December 2011. The
quality measures were selected based on recommended clinical
practice guidelines, including family history, history of neck
radiation, neck symptoms, TSH test, and thyroid ultrasound.

Results. The majority of patients were Caucasian females. Family
history of thyroid cancer and childhood neck radiation exposure
were documented in 79 subjects (40%) and 76 subjects
(38%), respectively. Neck symptoms were documented in most
subjects, including dysphonia (56.8%), dysphagia (69.9%), and
dyspnea (41.2%). Most subjects had a TSH measured and an ultrasound
performed prior to biopsy (75% and 86%, respectively).

Conclusions. It appears there is a gap between current patient
care and clinical practice guidelines for management of thyroid
nodules. Clinical history and ultrasound features for risk stratification
of UGFNA were lacking, which could reflect physicians’
unfamiliarity with the guidelines. As thyroid nodules are common,
enhancing knowledge of the current guidelines could improve
appropriate work-up. Further studies are needed to identify
factors associated with the poor compliance with clinical guidelines
in management of thyroid nodules. KS J Med 2017;10(1):1-2.