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Endocrine Surgery

(334) Non-Clinical Influences on Thyroid Nodule Management: A Survey Study

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Matthew O. Holdaway, Other: No relevant relationships to disclose.
Marcela A. Moran Mojica: No relevant relationships to disclose.
Neil R. Gildener-Leapman, MD: No relevant relationships to disclose.


Introduction: Our study aims to uncover the presence of non-clinical influences on thyroid management while exploring provider use of the various thyroid nodule risk stratification systems.

Methods: An electronic survey was administered at various medical centers from 12/2022 through 1/2023. Each participant was presented with four questions; there were two forms of each question, one being the control with a non-descript patient vignette and the other adding an additional psychosocial patient aspect. All other aspects of the question were identical. Each question includes a brief case history, accurate TI-RADS score, patient picture, and Ultrasound image. Questions were independently determined ‘correct’ according to American Thyroid Association (ATA) and TI RADS guidelines by an endocrinologist and thyroid surgeon.

Results: Our survey returned fifty physician responses for a total of 162 answers. Responses were significantly more correct according to ATA guidelines (n=41, 25.3%) compared to TI RADS guidelines (n=22, 13.6%) (Chi2=7.1133, p=0.008). Of the incorrect answers, 139 responses were considered over-management and one was considered under-management according to TI RADS while 96 responses were considered over-management and 25 under-management according to ATA. Patient anxiety, gender, socioeconomic status, and race had no significant effect on the number of correct responses according to both TI RADS and ATA guidelines. However, based on our survey, women were more likely to be managed with FNA compared to men for the same nodule (Chi2=4.5, p=0.0339).

Conclusions: Our results indicate that clinicians involved in the management and care of thyroid nodules are more likely to follow ATA rather than TI RADS guidelines. Although gender affected hypothetical patient management, it is encouraging to report no differences in accuracy of answers based on extra-clinical factors including race, socioeconomic status, or anxiety level of the patient.