Endocrine Abstracts

Background: A thyroid nodule is a discrete lesion within the thyroid gland, which can serve as a prelude to a spectrum of conditions ranging from a benign incidental growth to a full-blown invasive carcinoma. Thyroid nodules are very common in adult population. About 15% of the UK population have clinically detectable goitres or thyroid nodules, and the lifetime risk of developing a thyroid nodule is around 5 to 10%. In addition, there is increasing risk of thyroid cancers in the UK, numbers having more than doubled since the 1970s, and estimated to climb to 74% between 2014 and 2035. 1 Therefore, it is crucial to follow a defined protocol for investigation and risk stratification of such nodules, while ensuring judicious use of available resources.

Aim and Method: A retrospective study was undertaken in the East London District Hospital with the aim to assess the management of thyroid nodules in keeping with the guidelines published by British Thyroid Association Guidelines for Management of Thyroid Nodules (2014). We enrolled random patients who had been diagnosed with thyroid nodules on ultrasound imaging of the neck. We collected data from 50 patients, such as U score in their ultrasound reports, how they were followed up and the outcome of follow up. These data were analysed, by tracking their progress to date after being diagnosed with thyroid nodule.

Standards: We compared against the BTA thyroid nodule management guidelines (2014) which recommend that: (1) all thyroid ultrasounds should report U-score on thyroid nodules (2) U1-U2 nodules does not require fine needle aspiration cytology (FNAC) (3) U3-U5 requires further follow up with FNAC.

Result: According to this study, more than three-quarters of the cases appropriately met the standards defined in the BTA guidelines. Nearly ten percent of thyroid nodules were found to be thyroid cancers upon follow up. Less than 2% of ultrasound reports did not include a U score for thyroid nodule identified.

Conclusions: It was deduced that the follow up management plan for thyroid nodule cases was satisfactory within 2022. However, there are still some areas to emphasize for further perfection. It would be beneficial to introduce educational interventions including departmental teaching in order to ensure compliance to latest guidelines, for suitable follow up according to clinical indication, with the ultimate goal of positive impact on patient care.

References:

UK CR. Thyroid cancer statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/thyroid-cancer#heading-Zero (cited November 2019).