MON-399 Use of Neck Ultrasound in Older Adults with Thyroid Nodules

Abstract Disclosure: M. Papaleontiou: None. N. Francis-Levin: None. J. Ortlieb: None. E. Shao: None. M. Banerjee: None. M.R. Haymart: None. Context: Thyroid nodules are common in older adults, often prompting evaluation to detect thyroid cancer, despite majority being benign. Optimal use of neck ultrasound for thyroid nodule surveillance in older adults, particularly in the setting of comorbidities and competing causes of death, remains unknown. Objective: To evaluate the use of neck ultrasound for thyroid nodule surveillance in older adults and to assess subsequent cause of death.Methods: We used a dataset that combines the Centers for Medicare & Medicaid Services (CMS) data with the health data of Michigan Medicine patients between 2016 and 2020. We identified patients aged 65 years and older diagnosed with thyroid nodules (median follow-up 2 years, range 0-6 years). Demographic characteristics, number of comorbidities (range 0-6), frequency of neck ultrasound and cause of death were assessed.Results: Of the18,001 patients diagnosed with thyroid nodules, the median age was 75 years (range 65-105) and the majority were female (71.2%). Overall, only 29 (0.2%) died of thyroid cancer and 2,387 (13.3%) died of other causes. Patients who died of other causes had more comorbidities than those who died of thyroid cancer (mean 1.73, range 0-6 vs mean 1.2, range 0-5). During the study period, patients received an average of 2.26 neck ultrasounds (range 0-26), and those who died of causes other than thyroid cancer received an average of 1.28 neck ultrasounds (range 0-12).Conclusions: Older adults with thyroid nodules are more likely to die of causes other than thyroid cancer. Consequently, in older adults with multiple comorbidities and short life expectancy due to their comorbidities, neck ultrasound for thyroid nodule surveillance may be overused. There is an opportunity to improve high-quality care by mitigating unnecessary imaging. Presentation: Monday, July 14, 2025