Ultrasound Thyroid Order Guide

When to order a thyroid ultrasound

  • Thyroid ultrasound is considered the gold standard imaging test for characterization of thyroid nodules.
  • Incidental thyroid nodules are associated with up to 11% risk of malignancy. If multiple nodules are present, each nodule has an independent risk of malignancy.
  • Thyroid ultrasounds are recommended for incidental nodules based on patient age, nodule size, and risk criteria as defined by the American College of Radiology.1
  • The decision to pursue evaluation of an incidental nodule also depends on patient’s clinical situation and goals of care.

How to order a thyroid ultrasound

  • In Epic, order US Neck/Parathyroid/Thyroid (IMG1072)
    • This exam includes visualization and evaluation of the entire thyroid gland and bilateral cervical lymph nodes.
    • Any nodules will be characterized with further recommendations based on the American College of Radiology TI-RADS guidelines.2
  • DO NOT order “US Biopsy Thyroid, Bilateral” (IMG2882) or “US Thyroid/Parathyroid Biopsy” (IMG2866). These orders are reserved for ultrasound-guided biopsies/FNA of the thyroid.

References:

  1. Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee
  2. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee - Journal of the American College of Radiology (jacr.org)