{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T23:38:08Z","timestamp":1789429088640,"version":"build-2803163510"},"reference-count":14,"publisher":"The Endocrine Society","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,11,1]]},"abstract":"<jats:p>Radionuclide uptake and scan and sonogram, frequently ordered before referral to an endocrinologist, are expensive and poor predictors of thyroid nodule malignancy. We estimated costs of excessive imaging and other studies by reviewing the records of all patients (n = 70) referred to a single, consulting endocrinologist, for thyroid nodule evaluation in a 2-yr interval and subsequently, presenting only pertinent histories and results of physical examinations, thyroid function tests, and thyroid autoantibodies, to a second, reviewing endocrinologist (RE) who was blinded to diagnosis and management. Concordance in diagnosis and management between consulting endocrinologist and RE was 87.1% and 93.4%, respectively. Accuracy of diagnosis, loss of patient\u2019s time (8.7 h, average), and cost of unnecessary testing, defined as tests not required by the RE for diagnosis and management according to published guidelines, were determined. Unnecessary testing included 153 physician\u2019s office or diagnostic laboratory visits, 44 sets of thyroid function tests, 32 radionuclide uptake and scan, 39 thyroid sonograms, and 3 computed tomography scans. The total direct cost of unnecessary tests was estimated at $27,290 ($390\/patient) in addition to costs of 30 unnecessary physician\u2019s office visits. Only 2 of 8 surgical referrals required surgery, whereas 6 other patients required surgery, including 3 with papillary carcinoma. We conclude that early referral to an endocrinologist of patients with suspected thyroid nodules results in significant savings in cost of evaluation, patient\u2019s time, and increased diagnostic precision. Six of the 8 patients referred for surgery before endocrine consultation had benign thyroid disease that did not require surgery. Six additional patients were referred to surgery, 3 of whom had papillary thyroid carcinoma.<\/jats:p>\n               <jats:p>Early referral of patients with suspected thyroid nodules to an endocrinologist results in significant savings in both cost and patient\u2019s time as well as increased precision of diagnosis.<\/jats:p>","DOI":"10.1210\/jcem.83.11.5268","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T17:02:29Z","timestamp":1389200549000},"page":"3803-3807","source":"Crossref","is-referenced-by-count":40,"title":["Effect of Early Referral to an Endocrinologist on Efficiency and Cost of Evaluation and Development of Treatment Plan in Patients with Thyroid Nodules"],"prefix":"10.1210","volume":"83","author":[{"given":"Robert","family":"Ortiz","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth H.","family":"Hupart","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"DeFesi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin I.","family":"Surks","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071619143581800_R1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1056\/NEJM199302253280807","article-title":"Management of a solitary thyroid nodule.","volume":"328","year":"1993","journal-title":"N Engl J Med"},{"key":"2020071619143581800_R2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3322\/canjclin.47.1.5","article-title":"Cancer statistics.","volume":"47","author":"Parker","year":"1997","journal-title":"Ca Cancer J Clin"},{"key":"2020071619143581800_R3","first-page":"1","volume":"20","year":"1997"},{"key":"2020071619143581800_R4","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0002-9343(94)90321-2","article-title":"Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.","volume":"97","author":"Mazzaferri","year":"1994","journal-title":"Am J Med"},{"key":"2020071619143581800_R5","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1056\/NEJM198508153130707","article-title":"Nodular thyroid disease. 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