Adherence to Guideline Recommendations in Patients with Thyroid Nodules

Introduction. Thyroid nodules are common and fine-needleaspiration (FNA) biopsy is the standard of care for workupto exclude thyroid cancer. In this study, we examinedthe discrepancy between daily practice and recommendeddiagnostic approach for management of thyroid nodules,based on history taking, laboratory, and imaging studies. Methods. This was a retrospective chart review of 199 patientswho had ultrasound-guided fine needle aspiration(UGFNA) performed at a Midwest academic medicalcenter from January 2010 to December 2011. Thequality measures were selected based on recommended clinicalpractice guidelines, including family history, history of neckradiation, neck symptoms, TSH test, and thyroid ultrasound. Results. The majority of patients were Caucasian females. Familyhistory of thyroid cancer and childhood neck radiation exposurewere documented in 79 subjects (40%) and 76 subjects(38%), respectively. Neck symptoms were documented in mostsubjects, including dysphonia (56.8%), dysphagia (69.9%), anddyspnea (41.2%). Most subjects had a TSH measured and an ultrasoundperformed prior to biopsy (75% and 86%, respectively). Conclusions. It appears there is a gap between current patientcare and clinical practice guidelines for management of thyroidnodules. Clinical history and ultrasound features for risk stratificationof UGFNA were lacking, which could reflect physicians’unfamiliarity with the guidelines. As thyroid nodules are common,enhancing knowledge of the current guidelines could improveappropriate work-up. Further studies are needed to identifyfactors associated with the poor compliance with clinical guidelinesin management of thyroid nodules. KS J Med 2017;10(1):1-2