Some Physicians Are Ordering Thyroid Tests for Unsupported Reasons

While most thyroid ultrasound orders are warranted, researchers say guidelines could be clearer to help reduce over diagnosis of thyroid cancer.

11:00 AM

Author | Nicole Fawcett

Graphic of Thyroid
Image by Stephanie King.

Up to one-third of physicians reported sending patients for a thyroid ultrasound for reasons not supported by clinical care guidelines, a new study led by University of Michigan Rogel Cancer Center researchers finds.

Routine use of ultrasounds to detect cancerous thyroid nodules have led to a significant increase in thyroid cancer cases in recent years, although many are low risk and unlikely to cause serious harm.

Researchers surveyed 610 surgeons, endocrinologists and primary care physicians who were involved in thyroid cancer care. Physicians were given different patient scenarios and asked when they would schedule a thyroid or neck ultrasound.

Like Podcasts? Add the Michigan Medicine News Break to your Alexa-enabled device or subscribe for updates on iTunesGoogle Play and Stitcher.

An overwhelming majority of physicians said they used ultrasound for reasons that are supported by clinical care guidelines, such as a large nodule that can be felt or one seen on another imaging test. But 33% said they ordered an ultrasound because the patient wanted it and 28% said abnormal thyroid function tests drove their decision – a factor the Choosing Wisely Campaign specifically advises against.

Results are published in JAMA Surgery.

"This study is the first to look at why physicians are using thyroid ultrasound for patients. While often it's for clinically relevant reasons, a substantial number of physicians are not ordering them for reasons that are clinically supported," says senior study author Megan R. Haymart, M.D., Nancy Wigginton Endocrinology Research Professor of Thyroid Cancer and professor of internal medicine at Michigan Medicine.

SEE ALSO: For Low-Risk Thyroid Cancer Patients, Less May be More for Post-surgery Surveillance

When asked what most influenced their decisions for patients with thyroid nodules, 69% cited recent clinical guidelines. Haymart says this shows the situation is malleable.

"We can change behavior and help physicians use thyroid ultrasound more appropriately, which will reduce the incidence of low risk thyroid cancer," she says.

Organizations such as the National Comprehensive Cancer Network and the American Thyroid Association offer care guidelines based on data and outcomes from published studies. In addition, the Choosing Wisely campaign, which launched in 2012, identifies tests and procedures that should be discussed between patients and physicians to ensure appropriate and necessary treatment.

MORE FROM THE LAB: Subscribe to our weekly newsletter

"There is not specifically a guideline for when to order a thyroid ultrasound. The guidelines start once you find a nodule," says study first author Debbie W. Chen, M.D., an endocrinology fellow at Michigan Medicine. "Our study suggests there is an opportunity when working on the next set of guidelines to look a little upstream, before a clinical diagnosis, and offer better guidance for when thyroid ultrasound is necessary."

The key, researchers say, is to identify those thyroid cancers that will require treatment but to avoid over diagnosis by finding nodules that are slow growing and may never need treatment.

The finding that physicians were ordering thyroid ultrasounds because patients asked for them suggests a need for more education and discussion, Haymart says.

"There's so much emphasis in medicine on patient satisfaction. You do want patients to be satisfied, but physicians also have to do what's medically appropriate," she says. "Developing decision aids could help patients understand and decide when thyroid ultrasound is appropriate and when it's not."

Additional authors include David Reyes-Gastelum, Archana Radhakrishnan, Ann S. Hamilton and Kevin C. Ward

Funding: National Cancer Institute grant R01 CA201198, Agency for Healthcare Research and Quality grant R01 HS024512 and National Institutes of Diabetes and Digestive and Kidney Diseases grant T32DK07245

Paper cited: "Physician-reported misuse of thyroid ultrasound," JAMA Surgery. DOI: 10.1001/jamasurg.2020.2507

More Articles About: Industry DX Cancer Treatment Thyroid Cancer Cancer Research Health Care Delivery, Policy and Economics Cancer: Help, Diagnosis & Treatment
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories woman outside by water and woman with care team infusion
Health Lab
Immunotherapy saves woman with stage 4 colon cancer
A Michigan Medicine expert describes immunotherapy as “the future of cancer treatment” for those who qualify.
cancer cell
Health Lab
Language barriers in cancer care
Research from experts at Michigan Medicine shows that significant language-based disparities exist in patients’ access to cancer care services, and it’s well before their first appointment with a doctor. 
cars jammed on highway
Health Lab
Nearly one-fifth of older adults travel 50-plus miles to see a neurologist
A Michigan Medicine study finds older Americans with complex neurologic conditions travel may travel great distances for care, many of whom live in rural areas or regions with a limited number of specialists.
Health Lab
10 tips for cancer patients heading into their first infusion treatment
Cancer survivors who received treatment at the University of Michigan Health Rogel Cancer Center and infusion nurses demystify the experience by providing 10 helpful things to know ahead of time.
older person in bathroom stalls blue red outfit checkered floor
Health Lab
Older adults with digestive diseases experience higher rates of loneliness, depression
Michigan Medicine gastroenterologists and hepatologists find older adults with digestive diseases experience higher rates of loneliness, depression and lower perceived health
blood sample
Health Lab
Early findings suggest clinical and lab-based approach critical to tracking head and neck cancer recurrence
Early findings of two studies from the University of Michigan Rogel Cancer Center shed light on new ways to anticipate recurrence in HPV-positive head and neck cancer sooner. The papers, published in Cancer and Oral Oncology, offer clinical and technological perspectives on how to measure if recurrence is happening earlier than current blood tests allow, and provide a framework for a new, more sensitive blood test that could help in this monitoring.