Question/Statement: "I saw the internist yesterday. She has ordered an ultrasound of the thyroid just for good measure..."

The "just for good measure" part kind of concerns me.

• In general, there should be a good reason to order any test. Just ordering a test or an exam without a significant indication can get you down the wrong path and can lead to additional tests or unnecessary complications.

Every test has it’s +/-

• No test is perfect and therefore it can’t be interpreted in a vacuum.
• Every test has different degrees of sensitivity and specificity.
• Sensitivity refers to how good a test is at finding something subtle.
• Specificity refers to how much you can rely on a positive result being real.

So what’s the problem?

• A positive test result has more meaning if the disease was suspected to begin with. However, if the same test came back positive on someone healthy, then you got to ask yourself, is it a real result or a false positive?
• A better question would be, why order a test that is not indicated, because then you will not know what to do if the result comes back positive.
• Or worse, if you ignored everything else about the healthy patient except the positive test result, you might inappropriately treat them for something they don’t have.

Thyroid ultrasound:

• Unfortunately, thyroid ultrasound is one of those tests that is rather nonspecific. A thyroid ultrasound is nonspecific because you often can't tell what lesions are begin (good) or malignant (bad) just by the ultrasound appearance. Don’t get me wrong, I am not saying that thyroid ultrasound it a bad test. This is just one type of tool that works well for a particular job. You dont use a hammer when you need a screwdriver (unless you are going to make a mess of things).  Thyroid ultrasound, needs to be used appropriately to be relevant.
• So be warned, most people have abnormal looking thyroids on ultrasound. However, a few years back a bunch of doctors got together and created a consensus guideline to help sort out who should get a biopsy.
• Depending on what things look like on ultrasound, a biopsy may be recommended. This happens quite a bit.
• I use to do ultrasound guided thyroid biopsies all the time. Ill fill you in more if it comes to that.