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Thyroid Biology and Disease

SUN-416 - From Incidental Finding to Cancer Diagnosis: When Do We Order Thyroid Ultrasound?

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor

    Abstract Poster Presenter(s)

  • Felipe Larios Madrid, MD

    Research Fellow
    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Lima, Peru

    • Co-Author(s)

  • MB

    Mariana Borras-Osorio, MD

    Mayo Clinic
    Rochester, United States

  • YW

    Yuqi Wu, PhD

    Mayo Clinic
    Rochester, United States

  • David Toro Tobon, MD (he/him/his)

    Principal Investigator
    Mayo Clinic
    Rochester, Minnesota, United States

  • RL

    Ricardo Loor-Torres, MD

    Research Collaborator
    Ascension Saint Joseph
    Chicago, Illinois, United States

  • EC

    Esteban Cabezas, MD

    Mayo Clinic
    Rochester, United States

  • MM

    Maria Mateo Chavez, MD

    Mayo Clinic
    Rochester, United States

  • AC

    Ana Gabriela Claros, MD

    Mayo Clinic
    Rochester, Minnesota, United States

  • LV

    Luis Vilatuna Andrango, MD

    Research Trainee
    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, MN, United States

  • ML

    Maria Lizarazo Jimenez, MD

    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, United States

  • IA

    Ivan Mateo Alzamora, MD

    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, United States

  • MA

    Misk Al Zahidy, MS

    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, United States

  • MM

    Marcelo Montero, MD

    Research Trainee
    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, Minnesota, United States

  • EG

    Esteban Gomez Alvarez, MD

    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, United States

  • AP

    Ana Cristina Proano, MD

    Mayo Clinic
    Mayo Clinic, United States

  • CS

    Cristian Soto Jacome, MD

    Mayo Clinic
    Rochester, United States

  • JF

    Jungwei W. Fan, PhD

    Mayo Clinic
    Rochester, United States

  • OP

    Oscar Ponce-Ponte, MD, MSc

    Derriford Hospital
    Plymouth, United Kingdom

  • MB

    Megan E. Branda, MS

    Principal Biostatistician
    Mayo Clinic
    Rochester, Minnesota, United States

  • Naykky Maruquel Singh Ospina, MD

    University of Florida
    Gainesville, FL, United States

    • Senior Author/Primary Investigator(s)

  • Juan P. Brito, MD

    Care and AI Laboratory, Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic
    Rochester, MN, United States

Disclosure(s):
Felipe Larios Madrid, MD: No financial relationships to disclose
David Toro Tobon, MD: Immunovant Inc: Consultant ()
Background
Incidental thyroid nodules (ITNs) are a major driver of thyroid cancer overdiagnosis, largely through downstream evaluation initiated by thyroid ultrasound (TUS). However, how often ITNs undergo further evaluation with TUS in routine practice, and which factors prompt this step, remains poorly understood. We aimed to quantify TUS utilization after ITN detection, identify patient, imaging, and reporting associated factors with this practice, and report downstream diagnostic cascade outcomes.
Methods
We conducted a retrospective cohort study of adult patients with no previous thyroid disease who received thyroid-capturing imaging at Mayo Clinic sites from 2017 to 2023. We previously developed our own Natural Language Processing pipeline by fine-tuning two models: BioClinicalBERT, capable of identifying ITNs (F1 score 0.97) and Medical-NER, which extracted nodule characteristics (F1 score 0.81) from image reports across multiple modalities. Patients were grouped by whether they subsequently received a TUS. Primary outcomes were (1) prevalence of ITN, (2) factors associated with TUS utilization identified using multivariable LASSO logistic regression assessing patient, imaging, and nodular characteristics; and (3) downstream effects including biopsy, thyroidectomy, and thyroid cancer diagnosis, measured within 6 months of the index imaging study if no TUS was performed, or within 6 months of the TUS when it was performed.
Results
Among 115,683 patients, 8,426 (7.3%) had an ITN. Patients were predominantly female (64.5%) and White (88.3%), with a mean age of 61.7 years (SD 15.1). Most nodules were identified on computed tomography (80.8%) and on chest imaging (52.3%). Of patients with ITNs, 1,677 (19.9%) underwent TUS. In multivariable analysis, TUS use was associated with higher body mass index (OR 1.20 per 10-unit increase, 95% CI 1.08–1.33), nodule size ≥1.5 cm (OR 1.79, 95% CI 1.52–2.10), and radiologist recommendation for TUS (OR 2.51, 95% CI 2.12–2.98), while older age was associated with lower odds of TUS (OR 0.89 per 10-year increase, 95% CI 0.84–0.93). Receipt of TUS was strongly associated with thyroid nodule biopsy (OR 113.0, 95% CI 75.8–168.4), partial thyroidectomy (OR 72.0, 95% CI 29.2–177.8), and total thyroidectomy (OR 38.8, 95% CI 16.7–90.3) vs no TUS. All thyroid cancers (103 cases, 88% papillary) occurred among patients who underwent thyroid ultrasound, representing 6.1% of the TUS cohort.
Conclusions
One in five ITNs underwent TUS, initiating diagnostic cascades and thyroid cancer detection that may fuel overdiagnosis. Factors associated with TUS may inform future efforts to define appropriateness of ultrasound after incidental nodule detection and to reduce unnecessary testing and treatment.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*