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Don’t recommend ultrasound for incidental thyroid nodules found on CT, MRI or non-thyroid-focused neck ultrasound in low-risk patients unless the nodule meets age-based size criteria or has ...
Choosing Wisely®
American College of Radiology
Imaging of the neck performed to evaluate non-thyroid-related conditions commonly reveals thyroid nodules. Most are not malignant. Even if malignant, they are likely to have indolent behavior. Fine needle aspiration often fails to definitively characterize a lesion as benign owing to the limitations of cytologic evaluation. Consequently, some patients with incidentally-discovered benign nodules undergo unnecessary serial ultrasound imaging and/or surgery. Accordingly, patients without clinical ...
ver más ... 2017Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.
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American Academy of Pediatrics - Section on Endocrinology
Limit this study to children who have asymmetric thyroid enlargement, palpable nodules, or concerning cervical lymphadenopathy. Ultrasound can detect nodules that elude palpation, and one prospective series found that 31.5% of patients with Hashimoto’s thyroiditis will have thyroid nodules. The majority of these lesions, however, are not harmful. Overuse of ultrasonography results in needless health care costs and time expenditures for families. More importantly, insignificant findings can ...
ver más ... 2017Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.
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American Academy of Pediatrics - Section on Endocrinology
TSH levels can be slightly elevated in obesity but this is more likely a consequence of obesity and rarely true hypothyroidism. Free T4 levels are usually normal and if so there is no proven benefit to treatment when TSH is minimally elevated. Testing thyroid function in otherwise healthy children should be considered only if stature and/or height velocity is decreased in relation to the stage of puberty. There are significant limitations in the use of insulin levels as a marker of insulin ...
ver más ... 2017Avoid ordering Vitamin D concentrations routinely in otherwise healthy children, including children who are overweight or obese.
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American Academy of Pediatrics - Section on Endocrinology
Although a 25-hydroxyvitamin D concentration, reflecting both vitamin D synthesis and intake, is the correct screening lab to monitor for vitamin D deficiency, current evidence is not sufficient to suggest that screening in otherwise healthy including children who are overweight or obese is necessary or safe. Global consensus recommendations caution against population-based screening for vitamin D deficiency. The US Preventive Services Task Force also has noted that variability of current ...
ver más ... 2017Avoid ordering screening tests looking for chronic illness or an endocrine cause, including CBC, CMP, IGF-1, thyroid tests, and celiac antibodies, in healthy children who are growing at or above the ...
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American Academy of Pediatrics - Section on Endocrinology
Even in children who are below the 3rd percentile for height with a normal history and physical exam, the incidence of newly diagnosed pathology was found to be only about 1%. In patients who have significant short stature (e.g. ≤-2.5 SD) or who are well below their genetic potential based on parental heights, tiered or sequential screening may be considered.
ver más ... 2017