Endocrine Abstracts

Introduction: Palpable thyroid nodules have a prevalence of 4–7%, which increases with imaging. About 5% are malignant. Efficient management is essential. USG and FNAC are valuable in assessing and preventing unnecessary thyroidectomies. Objective To compare our practice with local and Royal College of Pathologists guidelines. Methods All thyroid nodule patients seen in clinic between April to September 2010 were included. Data collected included age, gender, TFT, thyroid autoantibody status, whether USG was requested by GP prior to referral, USG report for suspicious features, FNA needle size, Thy classification, non-diagnostic sample rate and final outcome.

Results: Total number of patients was 38 with 89 clinic visits. Mean age: 53 years (20–87). 79% were females. 87% were euthyroid. Thyroid auto antibodies were measured in 26%. Majority of patients had either solitary nodule (38%) or multinodular goitre (38%). GPs arranged USG prior to referral in 29% of patients. USG features of microcalcification and cervical lymphadenopathy were reported in 49% and 57% of reports. Orange needle is likely to give more diagnostic samples but the sample size is too small to conclude. Thy classification reporting was used only for 6% of episodes. When Thy classification was applied retrospectively, 48% were Thy 1, 16% were Thy1c, 13% were Thy2, 19% were Thy 2c, 3% were Thy 3a and 1% was Thy 3f. After diagnostic lobectomy Thy 3f became a hyperplastic nodule, 1 patient with 3a had 2 subsequent benign FNAs, and 2 were lost to follow-up. Non-diagnostic rate was 48% compared to <15% in guidelines. Recommendations To improve cytology reporting using Thy classification. Pilot project to find out whether having biomedical scientist on site to ensure adequacy of samples significantly reduces the non-diagnostic rate as reported in some centres. To improve radiological reporting of suspicious features. To reduce USG requests prior to referral.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.