Thyroid scintigraphy in the assessment of the solitary thyroid nodule: differences in practice patterns between family physicians and specialists.

Abstract

Objective: It has been shown that there is considerable variation in the diagnosis and management of the thyroid nodule. The purpose of this study was to investigate the differences in the practice of family physicians and specialists in ordering thyroid scans in the initial workup of patients with thyroid nodules.

Design: Retrospective electronic and paper-based chart review.

Setting: University Health Network, Toronto.

Participants: All patients who underwent thyroidectomy over a 2-year period.

Interventions: An audit of their preoperative diagnostic tests was performed, and the specialties of the ordering physicians were identified.

Results: One hundred ninety-four patients were assessed. Sixty-three patients (32.5%) were investigated exclusively by their family physician, 63 (32.5%) were investigated exclusively by a specialist, and 68 (35%) were investigated by both. Family physicians ordered thyroid scans in 51% of patients, whereas specialists ordered scans in 29% of patients (p<.001). The medical specialists ordered 36 scans (33.6%) in 107 patients, whereas the surgical specialists ordered 2 (8.3%) scans in 24 patients (p<.001).

Conclusion: Despite the limited role for thyroid scans in the initial workup of a solitary thyroid nodule, they are still frequently ordered, particularly by family physicians. We recommend publication of Canadian evidence-based guidelines for the management of thyroid nodules, similar to existing American guidelines, which could help reduce the amount of unnecessary testing.