Redefining Thyroid Nodule Evaluation: Demographics, Misleading Symptoms, and Diagnostic Challenges. Insights From a Multicenter Study

Objective: Thyroid ultrasound (US) is the cornerstone for diagnosing nodular thyroid disease, yet many US examinations are prompted by nonspecific local symptoms (LS) like dysphagia or a palpable neck mass (NM). The clinical utility of such referrals remains debated. Methods: This multicenter retrospective study analyzed 614 patients diagnosed with thyroid nodules (TNs) via US from 2 endocrinology centers in Italy between December 2021 and October 2022. Patients were grouped based on referral reason: symptomatic TNs, further subdivided into NM and LS, versus nonsymptomatic TNs. Clinical, ultrasonographic, and management data were compared. Results: Symptomatic TNs accounted for 28.7% of cases (19.2% NM, 9.5% LS). NM patients were younger, more often female, and had larger, often cystic or isthmic-located nodules than nonsymptomatic TN patients. Conversely, LS patients had no significant differences in thyroid volume or nodule size but showed a higher prevalence of gastroesophageal reflux disease. Fine-needle aspiration was more common in the NM group because of larger nodules, but malignancy rates did not differ across groups. Surgical rates were similar, whereas thermal ablation was more frequent in the NM group. Conclusions: A third of TNs are diagnosed during US prompted by LS, yet only NMs are associated with distinct nodule characteristics. Dysphagia and dysphonia were nonspecific and more related to gastroesophageal reflux disease than TNs. These findings support caution against overuse of US. Demographics, nodule features, and location should guide clinical suspicion and imaging decisions to avoid unnecessary imaging and interventions.