Efficient evaluation of thyroid nodules by primary care providers and thyroid specialists

Objective: To determine whether primary care providers and thyroid speciali sts at Gundersen Lutheran Medical Center are evaluating thyroid nodules eff iciently by following recently published clinical guidelines. Study Design: One-year retrospective chart review. Patients and Methods: We reviewed patient records from 1996 and tabulated t he use of fine-needle aspiration cytology, radionuclide scanning, and thyro id ultrasonography by 49 primary care physicians evaluating 81 thyroid nodu les and by 5 thyroid specialists evaluating 29 thyroid nodules. The results were compared with our previous findings and those recently reported by ot hers. Results: Fine-needle aspiration cytology was widely used by both groups of Gundersen Lutheran healthcare providers. primary care physicians used imagi ng studies modestly and generated $106 per patient in unnecessary costs. Th yroid specialists occasionally used radionuclide scanning but did not use t hyroid ultrasonography; they generated $41 per patient in unnecessary costs . Overall, the introduction of fine-needle aspiration cytology at our insti tution has reduced the use of radionuclide scanning from 90% to 12% and the use of thyroid ultrasonography from 30% to 10%. We also found that the fre quency of surgery in patients with thyroid nodules fell substantially, yet detection of thyroid cancer in the operative specimens increased from 16% t o 43% while the cost of removing a thyroid carcinoma decreased from $64,000 to $25,000. Conclusions: Fine-needle aspiration cytology, adopted as the initial test f or diagnosing thyroid nodules by most of our healthcare providers, has redu ced the use of imaging studies far below the frequency reported by others a nd has substantially decreased the cost of thyroid nodule management.