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KANSAS JOURNAL of M E D I C I N E                               recommended by the guidelines. There was also significant dis-
                                                                crepancy among sonographic description of thyroid nodules.
GUIDELINE RECOMMENDATIONS IN PATIENTS WITH
THYROID NODULES                                                    Tangpricha et al.8 reported in 1999 that the American As-
continued.                                                      sociation of Clinical Endocrinologists guidelines had not
                                                                been implemented fully among patients that presented with
RESULTS                                                         thyroid nodules. They also found that endocrine referral in-
	 There were 833 UGFNA cases performed at our institution       creased the rate of FNA performance, and the use of I-SCAN
during January 1, 2010 to December 31, 2011. The 199 random-    seemed to be over utilized (90%).8 The majority of our sub-
ly-selected patients represented 273 FNA cases. The study       jects were evaluated by primary care physicians and otolar-
group consisted of 37 (18.6%) males and 162 (81.4%) females,    yngologists, not endocrinologists. I-SCAN was performed
with a mean age of 55 ± 14 years. Of these, 72.9% were Cau-     less frequently in our study, which reflected a minority of
casian. Forty-four percent had hypertension, 18.6% had type     patients with low TSH. Radionuclide studies have become
2 diabetes mellitus, and 13.6% had coronary artery disease.     less utilized at present time, most likely due to the evolution
	 Nearly 40% were questioned about family history of thy-       of thyroid ultrasound and increased availability of FNA.9
roid cancer and childhood neck radiation history. Neck
symptoms were assessed for dysphonia, dysphagia, and dys-          The retrospective chart review design limits the interpretation
pnea in 58%, 70%, and 39% of subjects, respectively (Table 1).  of the findings. Our study is limited to FNA cases from our institu-
TSH value was documented in 75%; 86% of patients had an         tion and could underestimate the number of biopsies performed
ultrasound performed prior to biopsy. The ultrasound de-        at an outside institution. In this current study, we examined the
scriptions of 273 thyroid nodules are summarized in Table       discrepancy between daily practice and recommended guide-
2. None specified nodules which were taller than wide on        lines. In future studies, we plan to examine whether adherence
transverse view. I-SCAN was performed in 10% of subjects.       to guidelines could impact early discovery of thyroid cancer.

Table 1. Findings of concordance quality measures.                 A gap was revealed between current patient care and the rec-
                                                                ommended approach for management of thyroid nodules. Clini-
Concordance Quality Measures           Documented (%)           cal history and US features for risk stratification of UGFNA were
                                                                lacking, which could reflect physicians’ unfamiliarity with clini-
Family History of Thyroid Cancer       79 (39.7)                cal practice guidelines. As thyroid nodules are common, improve-
                                                                ment of knowledge of the current guidelines would be beneficial.
Childhood Radiation Exposure           76 (38.2)

Symptoms of Dysphonia                  113 (56.8)

Symptoms of Dysphagia                  139 (69.9)               ACKNOWLEDGMENTS
                                                                	 We would like to thank Dr. Sally Rigler, Dr. Jonathan Mahn-
Symptoms of Dyspnea                    82 (41.2)                ken, and Ms. Genny Gochenour for their assistance in research
                                                                planning and Dr. Fang Fan for her help with cytology data.
Presence of TSH values prior to UGFNA  149 (74.9)

Presence of thyroid US prior to UGFNA  171 (85.9)

Table 2. Findings of ultrasound description of thyroid          REFERENCES

nodules.                                                        1 Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines

Ultrasound Description            Number of Nodules (%)         for patients with thyroid nodules and well-differentiated thyroid

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Consistency (presence of solid,        135 (49.6)               2xHegedüs L. The thyroid nodule. N Engl J
     cystic, or mixed nodules)
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          Echogenicity                 98 (36.0)                3xTan GH, Gharib H. Thyroid incidentalo-

                                                                mas: Management approaches to nonpalpable

Presence or Absence of                 52 (19.1)                nodules discovered incidentally on thyroid imag-
   Microcalcification
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Margin of Nodules                      112 (41.1)               4xMandel SJ. A 64-year-old woman with a thyroid nod-

                                                                ule. JAMA 2004; 292(21):2632-2642. PMID: 15572721.

Cervical Lymphadenopathy               146 (53.7)               5xDavies L, Welch HG. Increasing incidence of thyroid cancer in the Unit-

Evidence of Growth                     80 (29.4)                ed States, 1973-2002. JAMA 2006; 295(18):2164-2167. PMID: 16684987.

                                                                6xHaugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid

                                                                Association management guidelines for adult patients with thyroid

	 Most FNA specimens were categorized as benign (81%). In-      nodules and differentiated thyroid cancer: The American Thyroid
determinate cytology, cytology suspicious for malignancy, and
malignant cytology were found in 8%, 6%, and 1% of subjects,    Association Guidelines Task Force on Thyroid Nodules and Differ-
respectively. Surgery was performed on 78 subjects (29%),
and 14 subjects (7%) were confirmed to have thyroid cancer.     entiated Thyroid Cancer. Thyroid 2016; 26(1):1-133. PMID: 26462967.

DISCUSSION                                                      7xREDcap database. Available at https://redcap.kumc.edu/
   The results showed that history-taking to identify clinical
                                                                redcap_v6.4.4/index.php?pid=1369. Accessed April 7, 2015.
risk factors for thyroid cancer were lacking in more than 50%
of patients. The majority of patients appropriately had TSH     8xTangpricha V, Hariram SD, Chipkin SR. Compli-
value and thyroid ultrasound performed prior to UGFNA as
                                                                ance with guidelines for thyroid nodule evalua-

                                                                tion. Endocr Pract 1999; 5(3):119-123. PMID: 15251681.

                                                                9xMeller J, Becker W. The continuing importance of thyroid scin-

                                                                tigraphy in the era of high-resolution ultrasound. Eur J Nucl

                                                                Med Mol Imaging 2002; 29(Suppl 2):S425-438. PMID: 12192542.

                                                                Keywords: thyroid nodules, ultrasound-guided fine needle aspiration, thyroid
                                                                stimulating hormone

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