Endocrine Abstracts

With widespread use of sensitive imaging techniques, an increasing number of thyroid nodules are being detected. Thyroid nodules are common and reported to occur in 60% of adults. Most are benign, asymptomatic and do not warrant further intervention. Once detected, however, most patients are referred to endocrinology and/or otorhinolaryngology services for further assessment, adding to the already lengthy waiting lists and contributing to patient stress. An audit was undertaken to assess the management of patients presenting to Galway University Hospital between July 2021 and July 2022 who underwent a fine-needle aspiration (FNA). A sub-set of 50 patients from this group were assessed. 94% had an ultrasound prior to FNA. 29.8% of ultrasound reports documented a formal EU-TIRADS score. 8.5% of ultrasounds were discussed at a multidisciplinary meeting (MDM) prior to FNA with a mean waiting time for discussion of 2.75 months. 6% of nodules were Thy 1, 32% were Thy 2, 48% were Thy 3, 8% were Thy 4 and 6% were Thy 5. 74% were discussed at an MDM following FNA. The mean waiting time for discussion post-FNA was 2.7 months. 66% were advised to have surgery. The mean waiting time for surgery was 1.6 months for Thy 5 nodules, 4.7 months for Thy 4 nodules, 7.4 months for Thy 3 nodules and 6.8 months for Thy 2 nodules. 26% of patients with a Thy 3 nodule who were advised to have surgery remain on the waiting list. These results highlight a deficiency in risk stratification of thyroid nodules. If all ultrasound reports had an EU-TIRADS score, it may reduce the number of unnecessary FNAs and thus unnecessary interventions. If an EU-TIRADS score is not included in the report, discussion at MDM or review by a radiologist with expertise in thyroid pathology prior to FNA is strongly advised.