Thyroid ultrasonography (US) usage has risen significantly over the past two decades, with annual increases of up to 21% in some healthcare systems. This review examines patterns in thyroid US usage, factors driving potential misuse, and strategies to mitigate overuse. While thyroid US provides valuable information on thyroid morphology and structure without radiation exposure, inappropriate use—estimated at 10–50% of exams—leads to adverse consequences, including patient anxiety, unnecessary procedures, and potential overdiagnosis of thyroid cancer. The widespread adoption of US has coincided with increased thyroid cancer diagnoses, yet mortality rates remain unchanged, suggesting overdiagnosis rather than actual disease increase. Clinical guidelines consistently recommend selective US use not for routine evaluation of thyroid dysfunction (hyper/hypothyroidism) without palpable abnormalities, but for the anatomical assessment of palpable nodules. For thyroid incidentalomas (ITNs), evidence suggests negligible malignancy risk for nodules < 1 cm, arguing against further investigation. The paper proposes a rational approach to thyroid US, emphasizing that patients with thyroid dysfunction without palpable abnormalities, euthyroid patients without palpable nodules, and patients with subcentimetric ITNs should not undergo thyroid US. Addressing this overutilization requires a better understanding of contributing factors and targeted interventions. By restricting US to appropriate clinical scenarios, healthcare resources can be optimized without compromising patient outcomes, ensuring that rare cases of clinically significant thyroid cancer receive proper diagnosis and treatment.
过去二十年间，甲状腺超声检查的使用率显著上升，部分医疗系统的年增长率高达21%。本文综述了甲状腺超声的使用模式、导致潜在误用的驱动因素以及减少过度使用的策略。虽然甲状腺超声能在无辐射暴露的情况下提供有价值的甲状腺形态与结构信息，但不恰当使用（估计占检查量的10-50%）会带来不良后果，包括患者焦虑、不必要的医疗程序以及潜在的甲状腺癌过度诊断。超声技术的普及与甲状腺癌诊断率的上升同步发生，但死亡率并未改变，这表明存在过度诊断而非实际疾病增加。临床指南始终建议选择性使用超声，不推荐用于无触诊异常的甲状腺功能障碍（甲亢/甲减）常规评估，而应用于可触及结节的解剖学评估。对于甲状腺偶发瘤，证据表明小于1厘米的结节恶性风险可忽略不计，因此不建议进一步检查。本文提出甲状腺超声的合理使用方案，强调以下情况不应进行甲状腺超声检查：无触诊异常的甲状腺功能障碍患者、无触诊结节的甲状腺功能正常者以及小于1厘米的甲状腺偶发瘤患者。解决这种过度使用问题需要深入理解相关影响因素并实施针对性干预措施。通过将超声检查限制在适当的临床场景中，可以在不影响患者预的前提下优化医疗资源配置，确保具有临床意义的罕见甲状腺癌病例获得正确诊断与治疗。
Thyroid Ultrasonography: Much Ado About Nothing? A Provocative Analysis
肿瘤(癌症)患者之家