title: Is TSH necessary for initial assessment of thyroid nodules?
abstract: OBJECTIVE
  The use of thyrotropin (TSH) in the initial assessment of thyroid nodules is inefficient and leads to unnecessary assessment costs. We compared the total costs of thyroid nodule assessment with or without the use of TSH in the initial assessment.
  
  
  METHODS
  A total of 1808 patients with thyroid nodules received TSH, fine-needle aspiration (FNA) and thyroid scintigraphy (TS) assessment, including 83 autonomously functioning thyroid nodule (AFTN) cases and 1725 non-AFTN cases. The total costs of the TSH strategy and non-TSH strategies were compared. The ratio of single-use costs of FNA to TS (CFNA/TS) was used as the main outcome measure.
  
  
  RESULTS
  Only when 6·03 ≤ CFNA/TS≤ 27·17, the lowest total costs were associated with using the conventional TSH strategy. When CFNA/TS<6·03 or CFNA/TS>27·17, the lowest costs were found with FNA and TS, respectively.
  
  
  CONCLUSIONS
  From the perspective of cost economics, in iodine-sufficient areas, we recommend that the decision on the use of TSH for the initial assessment of thyroid nodules should be based on the testing costs of FNA and TS in that medical unit.
authors: Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Haidong
authors: H
authors: Cai
authors: Department of Blood Transfusion, Changhai Hospital, Shanghai, China.
authors: Yu
authors: Y
authors: Qiao
authors: Department of Pathology, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Hao
authors: H
authors: Xi
authors: Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Qiong
authors: Q
authors: Luo
authors: Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Xueyu
authors: X
authors: Yuan
authors: Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Yuehua
authors: Y
authors: Yang
authors: Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
authors: Zhongwei
authors: Z
authors: Lv
mesh_terms: D044963:Biopsy, Fine-Needle; D003365:Costs and Cost Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D012372:ROC Curve; D011877:Radionuclide Imaging / Q000191:economics; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D013972:Thyrotropin / Q000008:administration & dosage* / Q000191:economics
chemical_list: D013972:Thyrotropin