Study Finds 1 in 13 Thyroid Ultrasounds Unnecessary, Raising Overdiagnosis Concerns

A significant portion of thyroid ultrasounds performed in the U.S. may be unnecessary, leading to potential overdiagnosis and avoidable follow-up procedures, according to new research published in JAMA Otolaryngology–Head & Neck Surgery.

Thyroid ultrasound is a key tool for diagnosing thyroid cancer, one of the fastest-growing cancer types in the country and the most common cancer among young adults. Despite this rise in diagnoses, mortality rates for thyroid cancer have remained stable, prompting concern that many detected cancers may pose “minimal or no threat to health.”

Researchers from the Mayo Clinic sought to quantify the prevalence of unnecessary thyroid scans and identify common contributing factors. Their analysis found that about 7.6% of first-time thyroid ultrasounds—roughly one in 13—were inappropriate based on established clinical guidelines.

“These findings highlight the need for targeted educational and system-level interventions to optimize the use of [thyroid ultrasound], which may reduce the risks of overdiagnosis and overtreatment of thyroid conditions,” wrote lead author Felipe Larios, MD, of Mayo Clinic’s Department of Medicine, and colleagues.

The study examined data from more than 11,000 adult patients across four Mayo Clinic sites between 2017 and 2021. Patients with a history of thyroid nodules, cancer, or surgery were excluded. Researchers then used a natural language processing model to assess whether ultrasound orders adhered to guideline-based appropriateness criteria.

They found that younger patient age, hyperthyroidism, orders placed by nonendocrinology specialties (including oncology and hematology), and scans requested without a recent in-person visit were all strongly associated with unnecessary imaging.

Compared to appropriate scans, these wasteful ultrasounds produced lower rates of thyroid nodule detection (23% vs. 65%), biopsies (10% vs. 25%), partial thyroidectomies (2% vs. 4%), and confirmed thyroid cancer diagnoses (2% vs. 4%).

Based on these findings, the authors proposed three primary strategies to reduce inappropriate thyroid imaging:

1. Education – Develop intensive, specialty-specific educational programs for clinicians outside endocrinology. Such training would focus on guideline-based evaluation of thyroid dysfunction and emphasize when imaging is and isn’t indicated.

2. Clinical Decision Support (CDS) – Implement robust CDS tools integrated into electronic health record (EHR) systems to flag potentially inappropriate orders. These tools could be especially useful when orders are placed for patients with thyroid dysfunction or without a recent in-person evaluation.

3. Patient-Facing Materials – Since some inappropriate orders originated from patient requests via online portals, providers could use clear, accessible educational resources and standardized messaging to explain appropriate imaging indications and manage expectations.

“Further research is needed to understand the underlying reasons for these associations and to develop targeted interventions, such as enhanced healthcare professional education and improved clinical decision support tools, to promote appropriate use of [thyroid ultrasound] and mitigate the risks of unnecessary procedures,” the authors concluded.

By focusing on education, decision support, and patient engagement, the researchers believe healthcare systems can reduce unnecessary imaging, cut costs, and limit the risks of overtreatment—without compromising the detection of clinically significant thyroid disease.