Thyroid Nodules: Reducing Overdiagnosis and Investigations
DOI:
https://doi.org/10.58931/cdet.2025.3243Abstract
Thyroid nodules (TN) are incredibly common, with approximately 5% of the population presenting with palpable TN. However, the widespread utilization of sensitive imaging techniques over the past few decades has led to a rapid increase in their prevalence. Notwithstanding the clinically palpable TN, the rate of incidental nodules picked up on imaging studies varies remarkably with the underlying imaging modality. For instance, the prevalence of TNs on computed tomography (CT) scans of the neck is reported to be 16.5%,3 FDG-PET to be 2% and on neck ultrasounds (US) well over 50%. The prevalence of TN is higher in females and increases with age, and while there has been little change in the overall reported incidence of palpable TNs, the rising prevalence can be almost exclusively attributed to the expanded use of imaging, particularly the widespread availability of sensitive US. It is estimated that over 60% of the population may have at least one TN.
References
Russ G, Leboulleux S, Leenhardt S, Hegedüs L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J. 2014;3(3):154–163. doi:10.1159/000365289 DOI: https://doi.org/10.1159/000365289
Acar T, Ozbek SS, Acar S. Incidentally discovered thyroid nodules: frequency in an adult population during Doppler ultrasonographic evaluation of cervical vessels. Endocrine. 2014;45(1):73-78. doi:10.1007/s12020-013-9949-3 DOI: https://doi.org/10.1007/s12020-013-9949-3
Song Z, Wu C, Kasmirski J, Gillis A, Fazendin J, Lindeman B, et al. Incidental thyroid nodules on computed tomography: a systematic review and meta-analysis examining prevalence, follow-up, and risk of malignancy. Thyroid. 2024;34(11):1389-1400. doi:10.1089/thy.2024.0313 DOI: https://doi.org/10.1089/thy.2024.0313
Grani G, Sponziello M, Pecce V, Ramundo V, Durante C. Contemporary thyroid nodule evaluation and management. J Clin Endocrinol Metab. 2020;105(9):2869–2883. doi:10.1210/clinem/dgaa322 DOI: https://doi.org/10.1210/clinem/dgaa322
Li R, Li G, Wang Y, Bao T, Lei Y, Tian L, et al. Psychological distress and sleep disturbance throughout thyroid nodule screening, diagnosis, and treatment. J Clin Endocrinol Metab. 2021;106(10):e4221-e4230. doi:10.1210/clinem/dgab224 DOI: https://doi.org/10.1210/clinem/dgab224
Pitt SC, Saucke MC, Wendt EM, Schneider DF, Orne J, Macdonald CL, et al. Patients' reaction to diagnosis with thyroid cancer or an indeterminate thyroid nodule. Thyroid. 2021;31(4):580-588. doi:10.1089/thy.2020.0233 DOI: https://doi.org/10.1089/thy.2020.0233
Luddy MK, Vetter R, Shank J, Goldner W, Patel A, Kotwal A, et al. Patient reported outcome measures of health-related quality of life and asthenia after thyroidectomy. J Surg Res. 2021;264:394-401. doi:10.1016/j.jss.2021.02.039 DOI: https://doi.org/10.1016/j.jss.2021.02.039
Topstad D, Dickinson JA. Thyroid cancer incidence in Canada: a national cancer registry analysis. CMAJ Open. 2017;5(3):E612-E616. doi:10.9778/cmajo.20160162 DOI: https://doi.org/10.9778/cmajo.20160162
Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375(7):614-617. doi:10.1056/NEJMp1604412 DOI: https://doi.org/10.1056/NEJMp1604412
Park S, Oh CM, Cho H, Lee JY, Jung KW, Jun JK, et al. Association between screening and the thyroid cancer "epidemic" in South Korea: evidence from a nationwide study. BMJ. 2016;355:i5745. Published 2016 Nov 30. doi:10.1136/bmj.i5745 DOI: https://doi.org/10.1136/bmj.i5745
Arroyo N, Bell KJL, Hsiao V, Fernandes-Taylor S, Alagoz O, Zhang Y, et al. Prevalence of subclinical papillary thyroid cancer by age: meta-analysis of autopsy studies. J Clin Endocrinol Metab. 2022;107(10):2945-2952. doi:10.1210/clinem/dgac468 DOI: https://doi.org/10.1210/clinem/dgac468
Paschke R, Ghaznavi S, Imran SA, Jacquier J, Lochnan H, Massicotte MH, et al. Follow-up and transition of care for low recurrence risk thyroid cancer patients in Canada. Eur Thyroid J. 2025;14(3):e250072. Published 2025 Jun 5. doi:10.1530/ETJ-25-0072 DOI: https://doi.org/10.1530/ETJ-25-0072
Edwards MK, Iñiguez-Ariza NM, Singh Ospina N, Lincango-Naranjo E, Maraka S, Brito JP. Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis. Endocrine. 2021;74(2):263–269. doi:10.1007/s12020-021-02820-z DOI: https://doi.org/10.1007/s12020-021-02820-z
Landry BA, Barnes D, Keough V, Watson A, Rowe J, Mallory A, et al. Do family physicians request ultrasound scans appropriately? Can Fam Physician. 2011;57(8):e299-e304.
Hoang JK, Langer JE, Middleton WD, Wu CC, Hammers LW, Cronan JJ, et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015;12(2):143-150. doi:10.1016/j.jacr.2014.09.038 DOI: https://doi.org/10.1016/j.jacr.2014.09.038
Durante C, Hegedüs L, Czarniecka A, Paschke R, Russ G, Schmitt F, et al. 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. Eur Thyroid J. 2023;12(5):e230067. Published 2023 Aug 14. doi:10.1530/ETJ-23-0067 DOI: https://doi.org/10.1530/ETJ-23-0067
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi:10.1089/thy.2015.0020 DOI: https://doi.org/10.1089/thy.2015.0020
Soto Jacome C, Segura Torres D, Fan JW, Garcia-Bautista A, Golembiewski E, Duran M, et al. Drivers of thyroid ultrasound use: a retrospective observational study. Endocr Pract. 2023;29(12):948-954. doi:10.1016/j.eprac.2023.09.006 DOI: https://doi.org/10.1016/j.eprac.2023.09.006
Jacome CS, Torres DS, Fan JW, Loor-Torres R, Duran M, Zahidy MA, et al. Thyroid ultrasound appropriateness identification through natural language processing of electronic health records. Mayo Clin Proc Digit Health. 2024;2(1):67-74. doi:10.1016/j.mcpdig.2024.01.001 DOI: https://doi.org/10.1016/j.mcpdig.2024.01.001
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 2017;14(5):587-595. doi:10.1016/j.jacr.2017.01.046 DOI: https://doi.org/10.1016/j.jacr.2017.01.046
Karkada M, Costa AF, Imran SA, Hart RD, Bullock M, Ilie G, et al. Incomplete thyroid ultrasound reports for patients with thyroid nodules: implications regarding risk assessment and management. AJR Am J Roentgenol. 2018;211(6):1348-1353. doi:10.2214/AJR.18.20056 DOI: https://doi.org/10.2214/AJR.18.20056
Hoang JK, Middleton WD, Tessler FN. Update on ACR TI-RADS: successes, challenges, and future directions, from the AJR special series on radiology reporting and data systems. AJR Am J Roentgenol. 2021;216(3):570-578. doi:10.2214/AJR.20.24608 DOI: https://doi.org/10.2214/AJR.20.24608
Hu XY, Wu J, Seal P, Ghaznavi SA, Symonds C, Kinnear S, et al. Improvement in thyroid ultrasound report quality with radiologists' adherence to 2015 ATA or 2017 TIRADS: a population study. Eur Thyroid J. 2022;11(3):e220035. Published 2022 Jun 14. doi:10.1530/ETJ-22-0035 DOI: https://doi.org/10.1530/ETJ-22-0035
Edwards M, Brito JP, Salloum RG, Hoang J, Singh Ospina N. Implementation strategies to support ultrasound thyroid nodule risk stratification: a systematic review. Clin Endocrinol. 2023;99(4):417-427. doi:10.1111/cen.14942 DOI: https://doi.org/10.1111/cen.14942
Bayona A, Benavent P, Muriel A, Abuchaibe C, Sharpe SC, Tarasova V, et al. Outcomes of repeat fineneedle aspiration biopsy for AUS/FLUS thyroid nodules. Eur J Endocrinol. 2021;185(4):497-506. doi:10.1530/EJE-21-0330 DOI: https://doi.org/10.1530/EJE-21-0330
Lévesque F, Payne RJ, Beaudoin D, Boucher A, Fortier PH, Massicotte MH, et al. Publicly funded molecular testing of indeterminate thyroid nodules: Canada's experience. J Clin Endocrinol Metab. 2025;110(4):e1031-e1037. doi:10.1210/clinem/dgae355 DOI: https://doi.org/10.1210/clinem/dgae355
Huang Y, Chan SJ, Wright JD, Kuo JH, McManus CM, Lee JA, et al. Does the adoption of molecular testing cause decreased thyroidectomy rates in a national cohort? A quasiexperimental study of high- versus low-adoption states. Thyroid. 2024;34(3):388-398. doi:10.1089/thy.2023.0651 DOI: https://doi.org/10.1089/thy.2023.0651
Wu J, Stewardson P, Eszlinger M, Khalil M, Ghaznavi S, Nohr E, et al. Development of a nomogram to integrate molecular testing and clinical variables to improve malignancy risk assessment among cytologically indeterminate thyroid nodules. Thyroid. 2025;35(5):508-515. doi:10.1089/thy.2024.0481 DOI: https://doi.org/10.1089/thy.2024.0481

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