TY - JOUR
T1 - Physical Examination of the Thyroid
T2 - Accuracy in Detecting Thyroid Nodules and Frequency of Additional Findings
AU - Jacome, Cristian Soto
AU - Garcia, Andrea
AU - Golembiewski, Elizabeth
AU - Loor-Torres, Ricardo
AU - Duran, Mayra
AU - Segura, Danny
AU - Toro-Tobon, David
AU - Fan, Jungwei W.
AU - Singh Ospina, Naykky
AU - Brito, Juan P.
N1 - Publisher Copyright:
© 2023 AACE
PY - 2024/1
Y1 - 2024/1
N2 - Objective: Thyroid palpation is a common clinical practice to detect thyroid abnormalities. However, its accuracy and potential for additional findings remain unclear. This study aimed to assess the diagnostic accuracy of physical exams in detecting thyroid nodules. Methods: A retrospective observational study was conducted on a random sample of adult patients who underwent their first-time thyroid ultrasound between January 2015 and September 2017, following a documented thyroid physical exam. The study assessed the performance of thyroid palpation in detecting 1 or multiple thyroid nodules, as well as the proportion of additional findings on ultrasounds due to false positive thyroid palpation. Results: We included 327 patients, mostly female (65.1%), white (84.1%), and treated in a primary care setting (54.4%) with a mean age of 50.8 years (SD 16.9). For solitary thyroid nodules, the physical exam had a sensitivity of 20.3%, specificity of 79.1%, an accuracy of 68.5%, negative predictive value of 81.8%, and positive predictive value of 17.6%. For detecting a multinodular goiter, physical exams demonstrated a sensitivity of 10.8%, specificity of 96.5%, accuracy of 55.4%, negative predictive value of 53.9, and positive predictive value of 73.9%. Among 154 cases with palpable nodules, 60% had additional nodules found in subsequent thyroid ultrasound. Conclusion: Thyroid physical exam has limited diagnostic performance and leads to additional findings when followed by a thyroid ultrasound. Future efforts should be directed at improving the accuracy of thyroid physical exams or re-evaluating its routine use.
AB - Objective: Thyroid palpation is a common clinical practice to detect thyroid abnormalities. However, its accuracy and potential for additional findings remain unclear. This study aimed to assess the diagnostic accuracy of physical exams in detecting thyroid nodules. Methods: A retrospective observational study was conducted on a random sample of adult patients who underwent their first-time thyroid ultrasound between January 2015 and September 2017, following a documented thyroid physical exam. The study assessed the performance of thyroid palpation in detecting 1 or multiple thyroid nodules, as well as the proportion of additional findings on ultrasounds due to false positive thyroid palpation. Results: We included 327 patients, mostly female (65.1%), white (84.1%), and treated in a primary care setting (54.4%) with a mean age of 50.8 years (SD 16.9). For solitary thyroid nodules, the physical exam had a sensitivity of 20.3%, specificity of 79.1%, an accuracy of 68.5%, negative predictive value of 81.8%, and positive predictive value of 17.6%. For detecting a multinodular goiter, physical exams demonstrated a sensitivity of 10.8%, specificity of 96.5%, accuracy of 55.4%, negative predictive value of 53.9, and positive predictive value of 73.9%. Among 154 cases with palpable nodules, 60% had additional nodules found in subsequent thyroid ultrasound. Conclusion: Thyroid physical exam has limited diagnostic performance and leads to additional findings when followed by a thyroid ultrasound. Future efforts should be directed at improving the accuracy of thyroid physical exams or re-evaluating its routine use.
KW - Thyroid nodules
KW - incidental findings
KW - overdiagnosis
KW - physical examination
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U2 - 10.1016/j.eprac.2023.10.002
DO - 10.1016/j.eprac.2023.10.002
M3 - Article
C2 - 37805101
AN - SCOPUS:85175479199
SN - 1530-891X
VL - 30
SP - 31
EP - 35
JO - Endocrine Practice
JF - Endocrine Practice
IS - 1
ER -