Clinical practice patterns in the management of thyroid nodules: The first survey from the Middle East and Africa

Abstract

Objective: We sought to scope the practices in managing thyroid nodules in the Middle East and Africa (MEA). Materials and Methods: Survey of a convenience sample of physicians concerned with the management of thyroid disease. Results: Two hundred and twelve responses are included. Fine needle aspiration (FNA) is performed chiefly using ultrasound guidance (74.9%), generally by radiologists (47.1%). Respondents have a lower threshold for FNA than recommended. Management depends on the FNA cytology, with the follicular lesion of undetermined significance/atypia of undetermined significance resulting in repeat FNA for cytology (40.7%), immediate referral for thyroid surgery (32.9%), or molecular testing (13.2%). Follicular neoplasms are referred for lobectomy or total thyroidectomy by 81.6% of respondents. Nodules suspicious for malignancy are referred for thyroid surgery by 76.6% and for molecular testing by 20.1%. Respondents are less likely to perform FNA in an octogenarian than a younger patient with a comparable nodule. For a multinodular goiter, 29.9%, 25.9%, or 17.8% of respondents would, respectively, sample the largest 2–3 nodules, single largest nodule, or all nodules >1 cm in size. During pregnancy, respondents would perform FNA with nodular growth (27.1%) in the absence of nodular growth (25.6%), but more respondents (35.2%) would defer FNA until after pregnancy. Conclusions: The physicians' survey revealed a practice pattern in managing thyroid nodules in the MEA region, including both agreements and deviations from current guidelines. Focused quality assurance exercises, education, and research are needed.

Diagnosis and Management of Polycystic Ovary Syndrome: A Survey of Physicians from the Middle East and Africa

“…Yet, physicians' surveys do provide new information when applied to new settings. [19][20][21] The relatively small sample size also limits the survey. However, it remains a valid exploratory exercise to scope the perception of an important clinical condition in our region.…”

Doctors' Perceptions of Rare Bone Disorders and X-Linked Hypophosphatemia: A Survey from Africa and the Middle East

“…Consequently, several questions were added to the survey to help define the demographic and professional profiles of the respondents and their practices, similar to our previously published studies. [16][17][18] Summary statistics were prepared for responses to each question. Because not every participant answered all questions, the percentage of respondents providing a given answer was calculated individually for each question, using the number of respondents to that question in the denominator.…”

“…Consequently, several questions were added to the survey to help define the demographic and professional profiles of the respondents and their practices, similar to our previously published studies. 16 17 18…”

“…[13][14][15] Several surveys on the management pattern of common endocrine conditions in the Middle East and Africa (MEA) region have been recently conducted. [16][17][18] In the present study, we wished to scope the awareness and perception of physicians in the MEA region concerning certain genetic and metabolic bone diseases in general and XLH as an example of a condition with both conventional and specific therapy. The principal aim was to provide baseline information/data to direct future education.…”

Physicians' and Patients' Perceptions and Practices Concerning Antithyroid Drug-Induced Agranulocytosis

“…As previously described, a web-based commercial survey management service (Survey Monkey, Palo Alto, California, United States) was used. 15 16 17 18 19 20 All participants received an initial email or a link explaining the rationale of the survey and what is required from the consented participants, followed by five subsequent reminder emails/messages during the study period. The survey web site was open from August 1, 2017, to January 31, 2018.…”