Letters Investigating thyroid nodules

What about the cost?

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1370 (Published 07 April 2009) Cite this as: BMJ 2009;338:b1370
  1. Piero Baglioni, consultant physician1,
  2. Oneybuchi Okosieme, consultant physician1
  1. 1Prince Charles Hospital, Merthyr Tydfil CF47 9DT
  1. piero.baglioni{at}nglam-tr.nhs.uk

    As practising clinicians, we believe that Mehanna and colleagues’ review on investigating thyroid nodules should have been accompanied by a formal cost-benefit analysis because of its potential public health implications.1

    As the authors acknowledge, ultrasonography detects thyroid nodules in 50-70% of unselected adults in the general population but cannot obviate the need for fine needle aspiration cytology, which dictates further management. Fine needle aspiration cytology, even when performed and interpreted by experienced operators (a precondition not to be taken for granted outside dedicated institutions) has a false negative rate of up to 6% and a non-diagnostic rate of up to 30%. We are therefore uneasy about the advice to subject patients to hemithyroidectomy (with its inherent risks, costs, and unavoidable scars) if two aspiration procedures prove to be non-diagnostic.

    The need to confirm that the required diversion of resources is worth while is even more urgent if all patients with non-palpable incidentally detected nodules of less then 10 mm are to be investigated. The authors advise this while acknowledging that it is not supported by current guidelines from the British and American Thyroid Associations.


    Cite this as: BMJ 2009;338:b1370


    • Competing interests: None declared.


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