Point of Care Thyroid Ultrasound (POCUS) in Endocrine Outpatients: A Pilot Study

BACKGROUND: Thyroid ultrasound is used for the assessment and characterisation of thyroid nodules/goitres and to guide diagnostic biopsy, it is normally performed by radiologists. Point of care ultrasound (POCUS) by trained non-radiologists, has the potential to reduce cost, expedite diagnosis and enhance patient satisfaction if embedded in an outpatient clinic setting. AIM: To perform a pilot of the use of point of care thyroid ultrasound in an endocrine outpatient setting for the assessment of thyroid nodules and goitres. METHODS: Thyroid ultrasound was undertaken with consultant radiologist supervision, over a period of 16 months between January 2017 to April 2018. Using a GE Logic e7 portable thyroid ultrasound machine with 12 MHz linear probe. All scans were performed on patients attending for assessment of thyroid disorders at the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast. RESULTS: Thyroid ultrasound was performed on 40 patients (M:10,F30), mean age 52 years, range 23-77 years, median follow up 14 months, range 6-18 months. Twenty scans were performed to assess thyroid nodules, 13 for investigation of a goitre and the remaining 7 were for patient preference. 39 patients had benign thyroid disease, 1 patient had a confirmed newly diagnosed papillary thyroid carcinoma (PTC). The ultrasound ‘U' classification was U1 and U2 (n=37), U3 and above (n=3). Fine needle biopsy (FNA) was performed on 9 patients with one confirmed as a thyroid carcinoma (Thy1;n=2, Thy2;n=6 and Thy 5;n=1). Thyroid ultrasound reporting was broadly similar between radiologist and non-radiologist (p< 0.01). Time to scan was reduced during the pilot from the existing model (n=40) of a mean of 52 days (range 7-95 days) to 1 day (p<0.01). CONCLUSION: With appropriate training and radiology supervision, point of care thyroid ultrasound can be performed accurately and safely in outpatients by an endocrinologist. There are potential benefits in terms of cost savings, time to scan, reduction in clinic visits, and in expediting diagnosis.