Endocrine Abstracts

Thyroid nodules are common in the general population. In 2006, we audited and discovered that primary care direct access to thyroid ultrasound (TUS) has limited value in detecting sinister thyroid pathology. To improve quality of thyroid nodule management, in May 2007, we introduced four changes (1) appointed a thyroid MDT coordinator, (2) produced a thyroid nodule proforma to guide primary care referrals, (3) established the rapid access one-stop thyroid ultrasound FNA clinic (jointly run by Radiologist and Endocrinologist), (4) used an internally developed and validated clinical and ultrasound scoring system to aid the decision for fine needle aspiration (FNA). We completed the audit cycle, comparing with our previous practice, to determine the best practice to follow.

Sixty-eight patients were seen in this new service (May–December 2007). Mean age was 44.8 (S.D. 15.82). Twenty-three underwent FNA -16 were benign colloid lesions and 7 neoplastic (6 follicular, 1 papillary). In comparison, the 2006 audit analysed 77 subjects who were referred for TUS directly via primary care (January–June 2006, mean age 42.9 (S.D. 15.96)). Thirteen underwent FNA, which revealed 9 cases of benign disease, 1 case of follicular adenocarcinoma, but 3 insufficient FNAs were lost to follow up.

Educating primary care to be thyroid nodule aware and encouraging them to use a one-stop thyroid clinic has led to an increased efficiency to pre-select patients who require FNA and has detected more thyroid neoplasms. More importantly, the new clinic format demonstrated a low clinical risk to the management of potential patients with thyroid neoplasm.