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Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis

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Abstract

Purpose

Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid cancers that will not increase mortality. A primary driver of thyroid cancer overdiagnosis is ultrasound use. It is therefore valuable to understand how inappropriate use of thyroid ultrasound is defined, analyze the current evidence for its frequency, and identify interventions to lessen misuse.

Methods

Ovid MEDLINE(R), Ovid EMBASE, and Scopus databases were searched from inception to June 2020 for studies assessing inappropriate use of thyroid ultrasound. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. We used a random-effects model with a generalized linear mixed approach to calculate the mean overall proportion estimates of inappropriate use.

Results

Seven studies (total n = 1573) met the inclusion criteria with moderate to high risk of bias. Inappropriate thyroid ultrasound use was described variably, using published practice guidelines, third-party expert reviewers, or author interpretations of the literature. The overall frequency of inappropriate thyroid ultrasound use was 46% (95% CI 15–82%; n = 388) and 34% (95% CI 16–57%; n = 190) among studies using guideline based definitions. The pooled frequency of iUS due to thyroid dysfunction (either hypothyroidism or thyrotoxicosis) was 17% (95% CI 7–37%; n = 191) and the frequency of iUS due to nonspecific symptoms without a palpable mass was 11% (95% CI 5–22%; n = 124). No study examined interventions to address inappropriate use.

Conclusions

Low quality evidence suggests that inappropriate use of thyroid ultrasound is common. Interventional studies aiming to decrease the inappropriate use of thyroid ultrasound are urgently needed.

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Code availability

Available on Figshare: https://figshare.com/s/94b8b01d083e87b0b30f.

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Funding

No funding was provided for this endeavor. N.S.O. was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA248972. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. S.M. was supported by the Arkansas Biosciences Institute, the major research component of the Arkansas Tobacco Settlement Proceeds Act of 2000, and by the United States Department of Veterans Affairs Health Services Research & Development Service of the VA Office of Research and Development, under Merit review award number 1I21HX003268-01A1. The views expressed in the article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Matthew K. Edwards

  2. Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Nicole M. Iñiguez-Ariza

  3. University of Florida, Division of Endocrinology, Department of Medicine, Gainesville, FL, USA

    Naykky Singh Ospina

  4. Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First Street Southwest, Rochester, MN, 55905, USA

    Eddy Lincango-Naranjo & Juan P. Brito

  5. CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador

    Eddy Lincango-Naranjo

  6. Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Spyridoula Maraka

  7. Central Arkansas Veterans Healthcare System, Little Rock, AR, USA

    Spyridoula Maraka

  8. Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    Juan P. Brito

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Contributions

M.K.E. carried out the collection of data and drafted the manuscript. N.M.I-A. carried out the selection and collection of data and reviewed the manuscript. N.S.O. conceived of the study, participated in its design, and reviewed the manuscript. E.L-N. performed statistical analyses and reviewed the manuscript. S.M. conceived of the study, participated in its design, and reviewed the manuscript. J.P.B. conceived of the study, participated in its design, carried out selection of data, performed statistical analyses, and drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Juan P. Brito.

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Edwards, M.K., Iñiguez-Ariza, N.M., Singh Ospina, N. et al. Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis. Endocrine 74, 263–269 (2021). https://doi.org/10.1007/s12020-021-02820-z

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