A nurse practitioner-led thyroid nodule clinic reduces barriers to timely evaluation and treatment of thyroid disease.

BACKGROUND

Identification of thyroid nodules has increased over time, presenting a challenge for clinicians and health systems. Care may be delayed and completion of evaluation may require several visit. There may be unnecessary use of fine needle aspiration (FNA) in nodules <1 cm or with very low risk ultrasound features.

LOCAL PROBLEM: At our academic institution, thyroid nodule evaluation took on average 109 days and several visits to complete.

METHODS

Patients referred for diagnostic evaluation of thyroid nodules before and after establishment of our thyroid nodule clinic (TNC) were identified. For both groups, we analyzed the time from identification of the nodule to completion of the diagnostic evaluation including ultrasound, FNA, and TSH measurement.

INTERVENTION: We developed an NP-led TNC. History and physical, thyroid ultrasounds, laboratory evaluation, and FNA were expedited and scheduled for a single visit. Results were discussed with the patient and recommendations sent to the referring provider 1 week later.

Results

The mean time from initial patient referral to completion of workup was 19 days after initiation of the TNC. This was improved from 103 days before the initiation of the TNC ( p < .01). A total of 98 nodules underwent FNA, and 33 were determined to not require FNA.

CONCLUSIONS

An NP-led TNC can decrease wait times for patients and can reduce overtreatment of thyroid nodules. Such a clinic can also expedite patient referral to procedural specialties if additional intervention is needed.