Choosing Wisely With the Korean Association of Endocrine Surgeons: Reducing Overuse in Thyroid Nodule and Cancer Care

초록

The Korean Association of Endocrine Surgeons (KAES) developed thyroid-specific Choosing Wisely recommendations to minimize low-value testing and intervention in the management of thyroid nodules and cancer. This review aims to summarize the evidence supporting five key recommendations: avoiding routine serum thyroglobulin testing in patients with thyroid nodules; avoiding routine 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) for nodules with indeterminate cytology; avoiding routine preoperative 18F-FDG PET/CT for initial staging of differentiated thyroid cancer (DTC); avoiding routine thyroid-stimulating hormone (TSH) suppression for benign thyroid nodules; and avoiding uniform postoperative TSH suppression to <0.1 mIU/L in all patients with DTC. Implementation feedback was assessed through a web-based survey distributed to all registered KAES members (n=1,483), with 72 responses (response rate, 4.9%). Approximately two-thirds of respondents reported awareness of the KAES Choosing Wisely recommendations, and most endorsed the need for the campaign in Korea. Across all five recommendations, respondents reported high perceived feasibility (84.7%–95.8%) and substantial self-reported adoption in their clinical practice (81.9%–95.8%). The most frequently cited barriers to consistent implementation were concerns related to medicolegal or professional responsibility and patient requests for additional testing. These findings reflect respondents’ perceptions and self-reported practices and should be interpreted with caution given the low response rate and potential selection bias. These recommendations are intended to support evidence-based, shared decision-making and should be applied with individualized clinical judgment.

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