Thyroid Ultrasound 101: `When is Thyroid Ultrasound Usage Past it’s Peak?
Thyroid ultrasound went from “useless” for diagnosis of thyroid nodules and cancer in the 80’s and 90’s to the best diagnostic and treatment for thyroid nodules and cancer in 2000 to 2017 to the present state of severe over-use resulting in too many people with small nodules having biopsies and surgery. How did we get here? It is easy to use, low costs, high profits, and any physician can do a thyroid ultrasound in his or her office.
I fought to get thyroid ultrasound accepted by my professor, but they thought it was only used to make money. I had a very difficult time at first to convince them that the information from thyroid ultrasound was valuable for diagnosis and treatment. Terry Davies MD as editor of the Journal Thyroid proclaimed he could not practice medicine without his thyroid ultrasound.
Then the flood gates opened and in 25 years everyone has an ultrasound and doing studies on everyone. By 2016 we found out that the great tool for good is now becoming a tool for trouble for many. Routine thyroid US by primary care, OB,Surgeons without an indication has caused a black mark on the use of US. Too many studies without indication results in many small harmless nodules to come to biopsy and surgery.
Just like any test or drug, at first its usefulness is questioned, then it is the greatest thing since sliced bread, but finally is seen as a cause of problems, before it reaches it’s final place in medical use. Thyroid ultrasound has reached that place where it is over-used and causing harm to patients. Next phase will be when it reaches it’s peak of necessary use that is not causing more harm than good.
In order to get to maximum benefits for thyroid ultrasound we need both physician and patient to be skeptical of any use of thyroid ultrasound not backed by solid indications.
- Refuse a routine thyroid ultrasound.There should not be any “routine” US.
- Do not get a free thyroid ultrasound at a health fair. If you have indications go to your endocrinologist.
- If you did get a routine thyroid ultrasound and a small nodule was found, do not panic and go for the biopsy. Small harmless nodules are very common and a review of the ultrasound and by an endocrinologist. These can be watched with yearly ultrasounds instead of a biopsy.
- If you panic and allow a biopsy and it is suspicious, see a thyroid specialist to determine if there are other tests to help you avoid having surgery. Mutations and classifiers can be done on the biopsy slides.
- Finally many small cancers can be followed instead of surgery, and many small cancers are now called benign and only need a lobe removed to confirm it is a benign tumor not cancer.
Richard Guttler MD,FACE,ECNU