Opportunistic Thyroid Assessment During Carotid Doppler Ultrasonography

Thyroid nodules are frequently encountered during carotid Doppler ultrasonography, yet their clinical significance remains uncertain. This prospective study evaluated the prevalence, management, and clinical yield of thyroid nodules detected during opportunistic thyroid assessment performed alongside carotid Doppler examinations. A total of 510 consecutive adult patients were enrolled between November 2025 and May 2026. Thyroid nodules were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Follow-up recommendations, fine-needle aspiration biopsy (FNAB) rates, cytopathological outcomes, and biopsy adherence were analyzed. Thyroid nodules were detected in 338 patients (66.3%). Follow-up ultrasonography was recommended in 58 patients (17.2%), and FNAB was recommended in 37 (11.0%). Biopsy was performed in 21 patients (56.8%). Three malignancies were identified, yielding an overall malignancy rate of 0.6% (3/510). Patients who did not undergo recommended biopsy were significantly older than those who underwent biopsy ( P =0.032), and biopsy adherence was lower among rural residents ( P =0.039). Although thyroid nodules were highly prevalent, the overall malignancy yield was low. An ACR TI-RADS–guided selective reporting strategy may reduce unnecessary investigations while maintaining detection of clinically significant thyroid cancer.