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TOPLINE:

Thyroid physical examination findings didn't correlate with ultrasonography findings in a cohort of patients where a majority showed no symptoms of thyroid enlargement; however, enhanced training in physical exams may improve outcomes.

METHODOLOGY:

• Screening thyroid nodules, which are generally visible and palpable, using ultrasonography may lead to the overdiagnosis of papillary thyroid cancers.
• This retrospective study assessed the diagnostic accuracy of physical exams in 327 adults (mean age, 51 years; 65% women) who underwent thyroid ultrasonography after a thyroid physical examination between 2015 and 2017 in the United States.
• Data regarding the site and size of thyroid abnormalities, obtained from the thyroid physical examination and ultrasonography, and patient symptoms were recorded.
• Thyroid ultrasonography was used as a reference to estimate the accuracy, positive and negative predictive value, and sensitivity and specificity of the physical examination.
• Subgroup analysis was conducted on the basis of nodule size, thyroid enlargement symptoms, and primary vs specialist care.

TAKEAWAY:

• The sensitivity and specificity of the thyroid physical examination for detecting any thyroid abnormality were 72% and 36%, respectively.
• The positive predictive value of the thyroid physical examination for the specific diagnosis of multinodular goiter was high (74%), with the negative predictive value higher in symptomatic patients than in asymptomatic patients (79% and 51%, respectively; P < .01).
• The positive predictive value for the diagnosis of thyroid nodules was low (18%); however, the specificity of the physical exam for detecting these nodules was higher in patients with anterior neck symptoms than in asymptomatic patients (100% and 62%, respectively; P < .01).
• The positive predictive value for the diagnosis of multinodular disease was higher (100%) when a specialist performed the physical examination vs when a primary care physician performed the examination (60%).

IN PRACTICE:

The author stated, "In my practice, many diagnoses of thyroid cancer are first identified by palpation performed by primary care physicians or noticed by relatives, and the careful evaluation of neck symptoms using TPE [thyroid physical examination] may facilitate early diagnosis of clinically significant thyroid cancers."

SOURCE:

The article by Christopher W. Rowe, Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, Australia, was published in Clinical Thyroidology and is a review of an article published in Endocrine Practice.

LIMITATIONS:

In the retrospective study, the indication for performing thyroid ultrasonography was unknown. The proportion of asymptomatic patients was high, which may have diluted the assessment of thyroid physical examination and ultrasonography to diagnose neck symptoms. Furthermore, the proportion of abnormalities identified using ultrasonography that would also be identified using physical examination was unclear.

DISCLOSURES:

No funding source was reported. The author declared no conflicts of interest.