Background: The rising overuse of thyroid ultrasound (TUS) without clear clinical indications contributes to overdiagnosis and escalating healthcare costs. Objective: This study assessed the prevalence of unwarranted TUS orders by primary care providers (PCPs) within a healthcare network, focusing on deviations from established clinical guidelines. Design: A retrospective analysis reviewed 1000 randomly sampled medical charts of patients (18-65 years) who received a PCP-ordered TUS between 2018-2020. The cohort was predominantly female (77. 70%) and White (91%), with a median age of 50 years. Main Measures: TUS orders were classified as justified or unjustified based on AACE/ACE/AME guidelines. Subsequent diagnostic procedures and direct patient costs of unnecessary ultrasounds were analyzed. Key Results: A significant 31. 3% of TUSs were deemed unjustified. Common reasons included hypothyroidism (52. 08%), dysphagia (12. 46%), and nonspecific diagnosis (11. 82%). Diagnosis codes often misrepresented true TUS reasons in 42. 9% of charts. Patients with justified TUS J o u r n a l P r e -p r o o findications were significantly more likely to undergo further workup (49. 9% vs. 26. 5%, p < 0. 0001). Unjustified ultrasounds did not yield thyroid cancer diagnoses or explain symptoms like dysphagia, but 25% led to a chain of further TUS. Unnecessary ultrasounds generated over 80, 000 in direct patient costs, indicating a substantial economic burden. Conclusions: A considerable proportion of TUS orders by PCPs lack guideline support, resulting in wasteful healthcare utilization and significant financial impact. Urgent adherence to optimal TUS indication criteria is crucial to optimize resource allocation and minimize potential patient harm from unnecessary procedures.
Jaiswal et al. (Wed,) studied this question.