Thyroid Nodule Surveillance in Transfusion-Dependent Thalassemia: A Comparative Ultrasonographic Study

<b>Background:</b> Thyroid nodules are common in the general population, and up to 15% may be malignant. Patients with transfusion-dependent thalassemia (TDT) are predisposed to endocrine complications, raising concern for thyroid malignancy. This study compared surveillance strategies between TDT patients and healthy controls (HCs). <b>Methods:</b> This cross-sectional study used thyroid ultrasonography (US) to identify and characterize thyroid nodules in patients with TDT and HCs. Nodule assessment was performed using the Thyroid Imaging Reporting and Data System and the Italian Consensus for the Classification and Reporting of Thyroid Cytology for FNAs. Rates of indicated but unperformed FNAs and confirmed thyroid cancer cases were recorded. Statistical comparisons were performed using Fisher's exact and chi-squared tests. <b>Results:</b> A total of 156 TDT and 101 HCs underwent thyroid US. Nodules were detected in 35.2% of TDT patients and 34.6% of HCs, with no difference in prevalence. Nodules were smaller in TDT patients, but suspicious ultrasound features and cancer prevalence were similar. Furthermore, 33.3% of TDT patients vs. 4.5% of HCs did not undergo indicated FNA (<i>p</i> = 0.021). <b>Conclusions:</b> Thyroid nodule prevalence and malignancy risk were comparable in TDT patients and HCs. A higher proportion of TDT patients missed indicated FNA procedures, revealing a critical gap in surveillance. Enhanced adherence to guideline-based follow-up is needed in thalassemia care.