Quianzon Celeste C L, Schroeder Pamela R
Division of Endocrinology, Diabetes and Metabolism, Union Memorial Hospital, Baltimore, MD, USA;
Division of Endocrinology, Diabetes and Metabolism, Union Memorial Hospital, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2015 Apr 1;5(2):27192. doi: 10.3402/jchimp.v5.27192. eCollection 2015.
The article studied the knowledge and practice patterns of primary care providers and internal medicine residents in their initial evaluation of thyroid nodules and determined whether their practice is in accordance with published guidelines by the American Thyroid Association and American Association of Clinical Endocrinologists.
A survey was distributed to primary care physicians (PCPs) and internal medicine residents at a community hospital in Baltimore and a chart review was conducted at the Diabetes and Endocrine Center in the same hospital.
A total of 47 physicians (70%) responded to the survey, 16 PCPs and 33 residents. Most responders (96%) will always obtain a TSH, and of these, 21% of PCP and 25% of residents will obtain a TSH without any other laboratory work-up. Fifty percent of the physicians (PCP, 75%; resident, 39%) will always obtain a thyroid ultrasound (p=0.043). Most physicians (97%) will refer for a fine-needle aspiration (FNA) biopsy of a nodule >1 cm. Sixty-two percent of the physicians will not put a euthyroid patient on levothyroxine suppression therapy. Many physicians (48%) are not aware of the AACE and ATA thyroid nodule guidelines. Most physicians (65%) have not read the guidelines. Of the 113 charts reviewed, TSH was obtained alone in 40% and with other laboratory tests in 74%. Thyroid ultrasound was done in 67%. Only one patient was on levothyroxine for levothyroxine suppression therapy.
Although many physicians were not aware of the guidelines, and a small number of physicians have read them, many PCP and residents responded in concordance with the guidelines in obtaining TSH, an ultrasound, performing FNA biopsy, and not providing levothyroxine suppressive therapy in euthyroid patients. No differences were found between the responses of PCP and residents except for obtaining an ultrasound. Chart review data also showed that majority of tests ordered for non-toxic thyroid nodule evaluation were in agreement with the guidelines. Limitations include low survey response rate among PCPs and that results are from one community hospital.
Our findings from the survey and chart review conclude that majority of primary care physicians were initiating the appropriate work up of thyroid nodules prior to referral to a specialist.
本文研究了初级保健提供者和内科住院医师在对甲状腺结节进行初步评估时的知识和实践模式，并确定他们的实践是否符合美国甲状腺协会和美国临床内分泌医师协会发布的指南。
向巴尔的摩一家社区医院的初级保健医生（PCP）和内科住院医师发放了一份调查问卷，并在同一家医院的糖尿病与内分泌中心进行了病历审查。
共有47名医生（70%）回复了调查问卷，其中16名PCP和33名住院医师。大多数回复者（96%）总会检测促甲状腺激素（TSH），其中，21%的PCP和25%的住院医师会在未进行任何其他实验室检查的情况下检测TSH。50%的医生（PCP为75%；住院医师为39%）总会进行甲状腺超声检查（p=0.043）。大多数医生（97%）会对直径>1 cm的结节进行细针穿刺抽吸（FNA）活检。62%的医生不会对甲状腺功能正常的患者进行左甲状腺素抑制治疗。许多医生（48%）不了解美国临床内分泌医师协会（AACE）和美国甲状腺协会（ATA）的甲状腺结节指南。大多数医生（65%）没有阅读过这些指南。在审查的113份病历中，仅检测TSH的占40%，同时进行其他实验室检查的占74%。进行甲状腺超声检查的占67%。只有1名患者接受左甲状腺素抑制治疗。
尽管许多医生不了解这些指南，且只有少数医生阅读过，但许多PCP和住院医师在检测TSH、进行超声检查、实施FNA活检以及不对甲状腺功能正常的患者提供左甲状腺素抑制治疗方面的做法符合指南。除了超声检查外，PCP和住院医师的回复未发现差异。病历审查数据还显示，为评估非毒性甲状腺结节所开具的大多数检查符合指南。局限性包括PCP的调查回复率较低，且结果来自一家社区医院。
我们从调查和病历审查中得出的结果表明，大多数初级保健医生在将甲状腺结节转诊给专科医生之前都进行了适当的检查。
