Thyroid Scintigraphy in the Assessment of the Solitary Thyroid Nodule: Differences in Practice Patterns between Family Physicians and Specialists
Bibliographic record
Abstract
OBJECTIVE: It has been shown that there is considerable variation in the diagnosis and management of the thyroid nodule. The purpose of this study was to investigate the differences in the practice of family physicians and specialists in ordering thyroid scans in the initial workup of patients with thyroid nodules. DESIGN: Retrospective electronic and paper-based chart review. SETTING: University Health Network, Toronto. PARTICIPANTS: All patients who underwent thyroidectomy over a 2-year period. INTERVENTIONS: An audit of their preoperative diagnostic tests was performed, and the specialties of the ordering physicians were identified. RESULTS: One hundred ninety-four patients were assessed. Sixty-three patients (32.5%) were investigated exclusively by their family physician, 63 (32.5%) were investigated exclusively by a specialist, and 68 (35%) were investigated by both. Family physicians ordered thyroid scans in 51% of patients, whereas specialists ordered scans in 29% of patients (p<.001). The medical specialists ordered 36 scans (33.6%) in 107 patients, whereas the surgical specialists ordered 2 (8.3%) scans in 24 patients (p<.001). CONCLUSION: Despite the limited role for thyroid scans in the initial workup of a solitary thyroid nodule, they are still frequently ordered, particularly by family physicians. We recommend publication of Canadian evidence-based guidelines for the management of thyroid nodules, similar to existing American guidelines, which could help reduce the amount of unnecessary testing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".