MON-577 Routine Thyroid Ultrasonography in Largely Latino Population with Hyperthyroidism Is Not Clinically Useful

Thyroid ultrasonography (US) is readily available and its use has escalated particularly by non-specialists in patients with thyrotoxicosis. According to the American Thyroid Association (ATA), thyroid US should be used in patients with an inconclusive diagnosis after usual clinical and laboratory evaluation has been completed. However, the availability and lack of risk has led to its inclusion into the routine workup of a hyperthyroid patient. In evaluating our preliminary information, we discovered a lack of valid pre-test rationale or benefits. However we sought to determine in a larger population of thyrotoxic patients the reason for US, the benefits in making a diagnosis, or discovery of thyroid cancer. Our study is the first to date to evaluate the utility and benefits of US use in thyrotoxicosis in a largely Latino population drawn from a safety net medical center. Patients were identified retrospectively with a diagnosis of thyrotoxicosis from the RUHS Medical Center. Inclusion criteria included Grave’s disease, hyperthyroidism, or thyrotoxicosis that had an US for any reason. We determined the demographics and thyrotoxicosis laboratory findings. All patients that had an US were reviewed for rationale listed in the chart, US findings, and subsequent interventions. We also determined any role of the US findings in diagnosis or choice of therapy. We evaluated 163 patients meeting the criteria out of 600 thyrotoxic patients. The mean age was 46 years with 88% being women. Most patients were Latino (112/163 or 68.7%). 17 of the patients were Non-Hispanic whites (10.4%), 27 were African American (16.6%), and 7 were of Asian descent (4.3%). The majority (61%) had an US with no stated reason and the others were based on a neck exam finding. The findings from the US did not contribute to the diagnosis of thyrotoxicosis in any case. Use of US discovered 46 nodules with an average size of 1.44 cm. An FNA was conducted in 24 patients with nodules resulting in 12 thyroid surgical interventions. FNA discovered 4 papillary thyroid cancers confirmed at surgery and one micro papillary cancer. One FNA mischaracterized a papillary cancer found to be benign. Our findings in a largely Latino population demonstrated that US are not entirely useful as a preliminary work up as the US findings did not generally contribute to the diagnosis of thyrotoxicosis. US did discover four low or intermediate risk papillary cancers but also resulted in nine additional surgeries for benign lesions. Our results suggest that within this population the clinical effectiveness of routine US appears to be marginal. Providers are encouraged to follow ATA guidelines in the use of thyroid US in thyrotoxicosis.