title: Brief report: Use and misuse of thyroid ultrasound in the initial workup of patients with suspected thyroid problems referred by primary care physicians to an endocrine clinic.
abstract: OBJECTIVE
  Thyroid ultrasound (TUS) plays an important but limited role in the evaluation of some complaints related to the thyroid gland. This study was designed to examine how primary care physicians use TUS before referring patients to an endocrine clinic.
  
  
  METHODS
  We audited all charts of first-time referrals for appropriateness of TUS use. Recommendations in practice guidelines and current textbooks defined appropriate indications for TUS: (1) patients with a thyroid nodule and a history of head or neck irradiation; (2) follow-up of patients with nodules not surgically removed; and (3) evaluation of patients with amiodarone-induced thyrotoxicosis.
  
  
  METHODS
  Endocrine referral clinic in a teaching hospital in Israel.
  
  
  RESULTS
  Two hundred and eight unselected referrals were reviewed. Sixty-nine (33%) of the patients presented with a TUS. Documented reasons for TUS were suspected thyroid mass (n=35, 51%), thyroid dysfunction (n=21, 30%), neck pain (n=5, 7%), dyspnea (n=4, 6%), and dysphagia (n=2, 3%). Of the 69 TUS reviewed, 64 (93%) were not appropriate.
  
  
  CONCLUSIONS
  Primary care clinicians obtain TUS studies in patients without recommended indications prior to referral to an endocrinologist.
authors.affiliation: Endocrine Unit, Soroka University Medical Center of Clalit Medical Services, Beer-Sheva, Israel. liel@bgu.ac.il
authors.forename: Yair
authors.initials: Y
authors.lastname: Liel
authors.forename: Nitay
authors.initials: N
authors.lastname: Fraenkel
mesh_terms: D000328:Adult; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000000981:diagnostic imaging*; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging; D014463:Ultrasonography / Q000706:statistics & numerical data