Q: Should I have a thyroid ultrasound?

A: Not unless you notice a mass, swelling or discomfort in your lower neck.

Otolaryngologists, dentists, and primary care physicians routinely examine the neck for evidence of head and neck cancer.  In the absence of obvious tumors, there is no evidence that specifically screening the thyroid for cancer improves life expectancy. To the contrary, the US Preventive Services Task Force recommended in 2017 that thyroid cancer screening may do more harm than good, as abnormal findings lead to unnecessary anxiety, further testing, and possibly surgery.

To share a personal experience, I (Dr. Armstrong) discovered a thyroid nodule on myself while training to use the ultrasound machine. This led to a needle biopsy that was reported as suspicious for cancer. I was scheduled for thyroid surgery, a delicate operation that can cause permanent hoarseness, hypothyroidism, and hypocalcemia, among the other usual risks of surgery. After consultation with my endocrinologist, I cancelled surgery on short notice and elected close follow up instead. After five years and several reassuring needle biopsies, the nodule has shown no growth.

The truth is, most people will develop some nodules in the thyroid over time. Most thyroid nodules are benign, and most thyroid cancers are not that dangerous. The most dangerous thyroid cancers, such as anaplastic carcinoma, grow quickly and metastasize early. Thus, it is not likely that an early anaplastic cancer will be detected on periodic screening. Early detection of slow-growing cancers does not prevent deaths from fast-growing cancers.

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Photo Source: ProVision Diagnostics