Evaluation of the Work-Up for Thyroid Nodules in Primary Practice Across Northern Ontario


In Northern Ontario, family medicine physicians are often in the position to work up thyroid nodules. Thus, it is important for family practitioners in rural settings to be aware of the appropriate investigations to follow up on thyroid nodules to avoid unnecessary patient anxiety, unwanted diagnostic surgeries and healthcare burden.


This quality improvement study was designed to evaluate the level of knowledge that family care providers have regarding thyroid nodule workup. 


This was a cross-sectional study design with 29 participants who were family medicine physicians in Northern Ontario, Canada. A standardized virtual survey was created to assess participants’ self-reported awareness of the guidelines on thyroid nodule evaluation as well as the diagnostic imaging system used to assess thyroid nodules for biopsy. IBM SPSS version was used for data calculation and analysis. 


51.70% were not aware of the thyroid nodule classification system and the recommendations from the Choosing Wisely Campaign as they related to the management of thyroid nodules. There was a statistically significant association between the awareness of clinical practice guidelines and making the correct decision regarding the next steps in management. 


Family practice physicians in Northern Ontario may benefit from knowledge translation initiatives about thyroid nodule workup to increase their awareness and comfort with thyroid nodule evaluation and follow-up. This study suggests that increased awareness would translate to an approach that is more congruent with the current guidelines. 

Keywords: Thyroid nodules; Family medicine; Choosing Wisely

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