The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography.
OBJECTIVE
Incidental thyroid masses identified during carotid duplex ultrasonography may represent clinically significant lesions.


METHODS
Retrospective review of a prospective database in a tertiary care referral center.


METHODS
A total of 2004 consecutive patients from January, 2000, through January, 2002, undergoing carotid duplex ultrasonography.


METHODS
After bilateral carotid duplex ultrasonography, selected patients additionally underwent 1 or more of the following: dedicated thyroid ultrasound, fine-needle aspiration biopsy, and/or partial or total thyroidectomy.


METHODS
The prevalence and type of thyroid abnormalities, correlation with a dedicated thyroid ultrasound, and results of histopathologic diagnosis.


RESULTS
One or more thyroid abnormalities were identified in 188 duplexes (9.4%) involving 168 patients. Abnormalities were unilateral in 84 patients (50.6%) and bilateral in 81 patients (49.4%). Seventy-seven abnormalities (47%) were cystic, 72 (43%) were solid, and 16 (10%) were of mixed consistency. Sixty-six of the patients (40%) went on to have formal thyroid ultrasounds. Forty-five patients (70.3%) had masses greater than 1 cm on ultrasound. Based on ultrasound findings, 29 of 66 (44%) underwent fine-needle aspiration biopsy, with 13 of 66 (19.7%) eventually undergoing surgery. Surgical pathology included 5 patients with cancer (3 with papillary cancer, 2 with follicular cancer), 4 patients with a follicular adenoma, and 2 with lymphocytic thyroiditis). Two additional patients were discovered to have parathyroid adenomas following further workup and surgery. Thyroid abnormalities identified during carotid duplex ultrasonography correlated with formal ultrasound in 64 of 66 (97%) patients. Measurement of the thyroid mass by carotid duplex strongly correlated with measurement by formal thyroid ultrasound (r = 0.95, P<.001). Two patients with unilateral masses noted on carotid duplex had a normal thyroid formal ultrasound.


CONCLUSIONS
Incidental thyroid abnormalities identified during carotid duplex ultrasound are common and contain clinically significant pathology. A multidisciplinary clinical pathway may facilitate the appropriate evaluation of these abnormalities.
Steele
Scott R
SR
Department of Surgery, Vascular Surgery Service, Madigan Army Medical Center, Fort Lewis, WA, USA. docsteele@hotmail.com
Martin
Matthew J
MJ
Mullenix
Philip S
PS
Azarow
Kenneth S
KS
Andersen
Charles A
CA
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018616:Ultrasonography, Doppler, Duplex