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Video

Head and Neck Surgery

(A542) Epidemiology and Guideline Adherence of Incidental Thyroid Nodules in Head and Neck Cancer Patients

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • PH

    Perry Burks Hammond, MD

    Resident Physician
    Old Dominion University
    Norfolk, Virginia, United States

    • Co-Author(s)

  • ID

    Isabel Dashtizad, BA

    Medical Student
    Old Dominion University
    Norfolk, Virginia, United States

    • Senior Author(s)

  • Jonathan Mark, MD

    Associate Professor
    Old Dominion University
    Norfolk, Virginia, United States

Disclosure(s):
Perry Burks Hammond, MD: No relevant relationships to disclose.
Isabel Dashtizad, BA: No relevant relationships to disclose.
Jonathan Mark, MD: No relevant relationships to disclose.


Introduction: Incidental thyroid nodules (ITNs) are frequently discovered during imaging for head and neck cancer (HNC). The ACR recommends thyroid ultrasound (TUS) for ITNs with high-risk features, ≥1 cm if < 35 years, or ≥1.5 cm if ≥35 years, while the ATA advises TUS for any ITN regardless of age or size. This study examines the epidemiology of ITNs and compliance with ACR/ATA guidelines in HNC patients at a multidisciplinary tumor conference.

Methods: This retrospective study reviewed ITNs in HNC patients discussed at a tumor conference (July 2023–May 2024). Data included demographics, HNC diagnosis, treatment, nodule characteristics, imaging, and pathology. Compliance with ACR/ATA guidelines was assessed based on nodule size, age, and FDG-PET avidity. Statistical analyses used Chi-square or Fisher’s Exact tests (p < 0.05).

Results: Among 390 patients, 18.1% (n=70) had at least one ITN, 5.6% (n=22) had two, and 2.6% (n=10) had three or more. The incidence rate (2018–2024) was 0.030 cases/person/year. The most common malignancy in ITN patients was squamous cell carcinoma (24.3% vs. 25.0% in non-ITN, p=0.90). No significant differences were found in clinical (p=0.31) or pathologic staging (p=0.63) between ITN and non-ITN patients. Among patients >65 years, 61.4% had an ITN, though not statistically significant (p=0.11). CT identified 73.8% of ITNs, followed by TUS (22.5%) and PET (3.8%). Thirteen patients (20.6%) had FDG-PET avid nodules; none received TUS, and 6 (35.3%) underwent FNA or biopsy per ACR/ATA guidelines. Of these, 2 (11.8%) were malignant, and one had a thyroidectomy. Only 9 (14.3%) ITNs were evaluated by TUS initially, and 1 (1.6%) on interval imaging. Early-stage (I-II) HNC was associated with thyroid pathology evaluation (p=0.01) but not TUS (p=0.47). ACR guideline compliance for TUS was 21.2% (p=0.18), and ATA compliance was 22.5% (p=0.28).

Conclusions: ITNs are prevalent in HNC patients, yet ACR/ATA guideline adherence remains low. Improved compliance could enhance ITN management, emphasizing the value of guideline-based assessment and multidisciplinary discussions.