BACKGROUND
Over the past 3 decades, the number of people diagnosed with thyroid cancer has tripled. Most of this increase is due to finding small, slow-growing, non-aggressive cancers, especially papillary thyroid carcinoma. A thyroid ultrasound is often the test ordered that identifies a suspicious thyroid nodule, which eventually leads to a thyroid cancer diagnosis. This raises an important question: who should actually get a thyroid ultrasound? In 1999, South Korea started a national cancer screening program providing neck ultrasounds even for people who had no symptoms. Over the next 12 years, the number of thyroid cancer cases in Korea increased 15-fold. However, most of these cancers were small and were not dangerous and likely didn’t need to be detected or treated at all.

Consequently, many professional organizations, including the American Thyroid Association, advise against ordering a neck ultrasound for asymptomatic patients without physical exam findings of an abnormal thyroid gland. Instead, thyroid ultrasound should be performed when there is a clear medical indication — such as to evaluate a thyroid nodule that can be felt on physical exam. Inappropriate thyroid ultrasounds, meaning those ordered without a valid reason, can lead to unnecessary biopsies and surgeries. While detecting cancer might seem helpful, thyroid surgery itself carries risks. It can lead to permanent hypothyroidism, infections, hoarse voice, and damage to the parathyroid glands (hypoparathyroidism). In many cases, doing the ultrasound in the first place led to complications that could have been avoided.

The current study evaluates the frequency of and factors associated with, as well as the overall impact of, inappropriate thyroid ultrasounds.

THE FULL ARTICLE TITLE
Larios F, et al. Factors and outcomes of inappropriate thyroid ultrasonography. JAMA Otolaryngol Head Neck Surg 2025;151(9):843-852

SUMMARY OF THE STUDY
Researchers studied thyroid ultrasound results from 11,442 adult patients who had their first scan between January 1, 2017, and December 30, 2021, at 4 Mayo Clinic sites.

They excluded anyone who had a known thyroid nodule or cancer, previous thyroid surgery, or a thyroid biopsy. Using artificial intelligence (AI), they reviewed the reasons for requesting the ultrasound and classified each as either appropriate or inappropriate. An ultrasound was considered inappropriate if it wasn’t a) ordered to check a lump found during a physical exam, b) to investigate for symptoms likely to be caused by thyroid nodules (i.e., pain, hoarseness, trouble swallowing), c) ordered because the patient had a personal or family history of hereditary thyroid cancer, or d) to investigate hyperparathyroidism.

Out of all the ultrasounds, 866 (7.6%) were considered inappropriate. These were more likely to be ordered for younger patients (ages 18–54), those with hyperthyroidism, and when the doctor was not an endocrinologist, especially in family medicine or oncology/hematology. Inappropriate scans were also more common when patients requested them through an online health portal.

Patients who had thyroid ultrasounds for inappropriate reasons were less likely to have thyroid nodules found, need a biopsy, or be diagnosed with thyroid cancer. The few thyroid cancers that were discovered by an inappropriate ultrasound were usually small and unlikely to cause serious health problems. Thus, skipping unnecessary thyroid ultrasounds is safe and does not increase the risk of missing dangerous or fast-growing thyroid cancers.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study identifies situations where thyroid ultrasound is most often misused, i.e. in younger patients, in those with hyperthyroidism, when the test is requested by a doctor who isn’t an endocrinologist, or when patients request the scan themselves. Experts in quality improvement can use this information to design targeted interventions that reduce unnecessary testing. More importantly, avoiding inappropriate thyroid ultrasound does not harm patients. Physicians can feel confident offering a thyroid ultrasound only when it’s truly indicated, ensuring patients receive the proper care without unnecessary tests.

— Philip Segal, MD

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