Choosing Wisely With the Korean Association of Endocrine Surgeons: Reducing Overuse in Thyroid Nodule and Cancer Care

The Korean Association of Endocrine Surgeons (KAES) developed thyroid-specific Choosing Wisely recommendations to minimize low-value testing and intervention in the management of thyroid nodules and cancer.This review aims to summarize the evidence supporting five key recommendations: avoiding routine serum thyroglobulin testing in patients with thyroid nodules; avoiding routine 18 F-fluorodeoxyglucose positron emission tomographycomputed tomography ( 18 F-FDG PET/CT) for nodules with indeterminate cytology; avoiding routine preoperative 18 F-FDG PET/CT for initial staging of differentiated thyroid cancer (DTC); avoiding routine thyroid-stimulating hormone (TSH) suppression for benign thyroid nodules; and avoiding uniform postoperative TSH suppression to <0.1 mIU/L in all patients with DTC.Implementation feedback was assessed through a web-based survey distributed to all registered KAES members (n=1,483), with 72 responses (response rate, 4.9%).Approximately two-thirds of respondents reported awareness of the KAES Choosing Wisely recommendations, and most endorsed the need for the campaign in Korea.Across all five recommendations, respondents reported high perceived feasibility (84.7%-95.8%)and substantial self-reported adoption in their clinical practice (81.9%-95.8%).The most frequently cited barriers to consistent implementation were concerns related to medicolegal or professional responsibility and patient requests for additional testing.These findings reflect respondents' perceptions and self-reported practices and should be interpreted with caution given the low response rate and potential selection bias.These recommendations