Retrospective Evaluation of Thyroid Nodules Detected During Carotid Doppler Ultrasonography
DOI:
https://doi.org/10.58600/eurjther2915Keywords:
carotid arteries, doppler, fine-needle, incidental findings, prevalence, thyroid noduleAbstract
Objective: This study aimed to determine the prevalence and malignancy risk of incidental thyroid nodules detected during carotid Doppler ultrasonography in patients without a prior history of thyroid disease.
Methods: This retrospective study included 475 patients who underwent carotid Doppler ultrasonography between January and July 2025. Patients with known thyroid nodules or a history of thyroidectomy were excluded. Demographic data, thyroid findings, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scores were recorded from radiology reports, and cytology results were noted when fine-needle aspiration biopsy (FNAB) had been performed. Statistical analyses were performed using the Mann–Whitney U and Chi-square tests, with p < 0.05 considered statistically significant.
Results: Thyroid nodules were incidentally detected in 272 of 475 patients (57.3%). The prevalence was 59.4% in females and 54.0% in males, with no significant sex difference (p = 0.28). Patients with nodules were significantly older than those without (65.2 ± 12.0 vs 61.4 ± 13.6 years, p = 0.003). The mean maximum nodule diameter was 10.5 ± 8.1 mm, and 30.1% of patients had nodules ≤ 5 mm. FNAB was performed in 15 patients; eight patients (2.9% of all 272 nodules) had cytology results that were malignant or suspicious for malignancy.
Conclusion: Incidental thyroid nodules are frequently detected during carotid Doppler ultrasonography. Most are benign, yet a small subset carries a risk of malignancy. Recognition and appropriate reporting of these findings are important for guiding further management and avoiding unnecessary interventions.
References
[1] U-King-Im JM, Young V, Gillard JH (2009) Carotid-artery imaging in the diagnosis and management of patients at risk of stroke. Lancet Neurol. 8(6):569–580. https://doi.org/10.1016/S1474-4422(09)70092-4
[2] Acar T, Ozbek SS, Acar S (2014) Incidentally discovered thyroid nodules: frequency in an adult population during Doppler ultrasonographic evaluation of cervical vessels. Endocrine. 45(1):73–78. https://doi.org/10.1007/s12020-013-9949-3
[3] Dean DS, Gharib H (2008) Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 22(6):901–911. https://doi.org/10.1016/j.beem.2008.09.019
[4] Malboosbaf R, Hosseinpanah F, Mojarrad M, Jambarsang S, Azizi F (2013) Relationship between goiter and gender: a systematic review and meta-analysis. Endocrine. 43(3):539-547. https://doi.org/10.1007/s12020-012-9831-8
[5] Bartolotta TV, Midiri M, Runza G, Galia M, Taibbi A, Damiani L, Palermo Patera G, Lagalla R (2006) Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography. Radiol Med. 111(7):989–998. https://doi.org/10.1007/s11547-006-0097-1
[6] Rad MP, Zakavi SR, Layegh P, Khooei A, Bahadori A (2015) Incidental Thyroid Abnormalities on Carotid Color Doppler Ultrasound: Frequency and Clinical Significance. J Med Ultrasound. 23(1):25–28. https://doi.org/10.1016/j.jmu.2014.04.005
[7] Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P; AACE/AME/ETA Task Force on Thyroid Nodules (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract. 16(3):468–475. https://doi.org/10.4158/EP.16.3.468
[8] Knudsen N, Laurberg P, Perrild H, Bülow I, Ovesen L, Jørgensen T. (2002) Risk factors for goiter and thyroid nodules. Thyroid. 12(10):879–888. https://doi.org/10.1089/105072502761016502
[9] Demir M, Yasar Y. (2025) Apparent Diffusion Coefficient as a Predictor of Microwave Ablation Response in Thyroid Nodules: A Prospective Study. Diagnostics. 15(19):2538. https://doi.org/10.3390/diagnostics15192538
[10] Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT (2017) ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 14(5):587–595. https://doi.org/10.1016/j.jacr.2017.01.046
[11] Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA (2023) The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 33(9):1039–1044. https://doi.org/10.1089/thy.2023.0141
[12] Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katanick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler RE (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology. 229(2):340–346. https://doi.org/10.1148/radiol.2292030516
[13] Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA (2005) The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography. Arch Surg. 140(10):981–985. https://doi.org/10.1001/archsurg.140.10.981
[14] Kamran M, Hassan N, Ali M, Ahmad F, Shahzad S, Zehra N. (2014) Frequency of thyroid incidentalomas in Karachi population. Pak J Med Sci. 30(4):793–797. https://doi.org/10.12669/pjms.304.4808
[15] Shafiq M, Shumaila, Jaffar T, Saleem S, Akhter N, Nadeem F, Mazhar MA (2022) Incidental detection of thyroid nodule on carotid color Doppler ultrasound in patients presenting with cerebrovascular diseases. Pak J Med Dent. 11(4):29–33. https://doi.org/10.36283/PJMD11-4/005
[16] Elaraj DM (2010) Evaluation of the thyroid nodule. Cancer Treat Res. 153:23–34. https://doi.org/10.1007/978-1-4419-0857-5_2
[17] Kwong N, Medici M, Angell TE, Liu X, Marqusee E, Cibas ES, Krane JF, Barletta JA, Kim MI, Larsen PR, Alexander EK (2015) The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab. 100(12):4434–4440. https://doi.org/10.1210/jc.2015-3100
[18] Mu C, Ming X, Tian Y, Liu Y, Yao M, Ni Y, Liu Y, Li Z (2022) Mapping global epidemiology of thyroid nodules among general population: a systematic review and meta-analysis. Front Oncol. 12:1029926. https://doi.org/10.3389/fonc.2022.1029926
[19] Panagiotou G, Komninou D, Anagnostis P, Linardos G, Karoglou E, Somali M, Duntas L, Kita M, Tziomalos K, Pazaitou-Panayiotou K (2017) Association between lifestyle and anthropometric parameters and thyroid nodule features. Endocrine. 56(3):560–567. https://doi.org/10.1007/s12020-017-1285-6
[20] Jiang H, Tian Y, Yan W, Kong Y, Wang H, Wang A, Dou J, Liang P, Mu Y (2016) The prevalence of thyroid nodules and an analysis of related lifestyle factors in Beijing communities. Int J Environ Res Public Health. 13(4):442. https://doi.org/10.3390/ijerph13040442
[21] Floridi C, Cellina M, Buccimazza G, Arrichiello A, Sacrini A, Arrigoni F, Pompili G, Barile A, Carrafiello G (2019) Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art. Gland Surg. 8(Suppl 3):S233–S244. https://doi.org/10.21037/gs.2019.07.01
[22] Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med. 328(8):553–559. https://doi.org/10.1056/NEJM199302253280807
[23] Taheri SM, Hemadi H, Haghighatkhah HR, Kamyar K, Jalali AH, Shakiba M. (2008) Prevalence of incidental thyroid nodules diagnosed by ultrasound in an Iranian population. Iran J Radiol. 5(1):19–23.
[24] Tan GH, Gharib H (1997) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 126(3):226–231. https://doi.org/10.7326/0003-4819-126-3-199702010-00009
[25] Kim PH, Suh CH, Baek JH, Chung SR, Choi YJ, Lee JH (2021) Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis. Eur Radiol. 31(5):2877–2885.
[26] Koc AM, Adıbelli ZH, Erkul Z, Sahin Y, Dilek I (2020) Comparison of diagnostic accuracy of ACR-TIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy. Eur J Radiol. 133:109390. https://doi.org/10.1016/j.ejrad.2020.109390
Downloads
Published
How to Cite
License
Copyright (c) 2026 Ali Salbas, Atakan Bayir
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
