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Surgeon-performed ultrasound in patients referred for thyroid disease improves patient care by minimizing performance of unnecessary procedures and optimizing surgical treatment.

BACKGROUND: Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation. This study examines the added benefit of office-based, surgeon-performed ultrasonography in patients referred for thyroid disease.

METHODS: All patients referred to a single endocrine surgeon for evaluation of thyroid disease over a 2-year period were reviewed. Outside ultrasonographic findings were compared to the surgeon-performed ultrasound that was used to formulate treatment decisions.

RESULTS: Of 286 consecutive patients referred for surgical evaluation of thyroid disease, 261 had an outside ultrasound available for comparison. There were 239 women and 47 men. Mean age was 54.7 +/- 16.6. In 46 patients (17.6%), differences between the two ultrasounds were significant enough to alter treatment plans. For 18 patients no distinct nodule was identified and biopsy was avoided. Nine of these patients had ultrasound characteristics of Hashimoto's disease. In five patients the nodule was significantly smaller than reported and biopsy was not warranted. Twelve patients had nonpalpable, enlarged lymph nodes not previously identified; these were biopsied. Three were positive for metastatic thyroid cancer, which prompted the addition of neck dissection to the operative procedure. In 8 of 132 patients undergoing thyroidectomy, the surgical procedure was significantly altered by the ultrasound findings.

CONCLUSIONS: This study demonstrates a clear advantage for patients who undergo a surgeon-performed ultrasound. For many, unnecessary procedures were prevented. For others, substantial modifications to the extent of surgery were made when new ultrasonographic findings were identified during the preoperative investigation.

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