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Background: Incidental thyroid nodules (ITNs) are frequently identified on neck and chest computed tomography (CT) scans performed for non-thyroid indications. Their detection poses a clinical challenge in deciding appropriate follow-up and management, especially considering the potential risk of malignancy. Objectives: To assess the prevalence, radiological characteristics, and follow-up patterns of incidental thyroid nodules detected on neck and chest CT scans in a tertiary care hospital. Methods: This retrospective observational study included 100 patients who underwent neck or chest CT scans for unrelated clinical reasons. All images were reviewed to identify and characterize ITNs in terms of size, location, morphology, and follow-up recommendations. Data were extracted from radiology reports and patient medical records. Results: Incidental thyroid nodules were detected in 27 patients (27%). The mean age of patients with ITNs was 54.3 ± 12.6 years, with a female predominance (66.7%). Most nodules were <2 cm in size, and the majority were located in the right lobe. Morphologically, 59.3% were solid, 29.6% were mixed cystic-solid, and 11.1% were purely cystic. Follow-up imaging or FNAC was recommended in 74.1% of cases, but only 44.4% of patients underwent further evaluation. Among them, 16.7% of nodules were suspicious or malignant. Conclusion: ITNs are common findings on routine CT scans. Although a significant proportion may be benign, structured reporting and consistent follow-up are essential to identify malignant lesions early and guide appropriate management.
Incidental thyroid nodules (ITNs) are increasingly identified on cross-sectional imaging, particularly on neck and chest computed tomography (CT) scans performed for non-thyroid-related clinical indications. The rising use of advanced imaging has contributed to a greater detection rate of these nodules, often posing a clinical dilemma regarding their evaluation and management [1,2].
Studies have reported that the prevalence of ITNs on chest CT ranges from 16% to 25%, depending on the imaging protocol and population studied [2,3]. Although most ITNs are benign, a small but important proportion may represent clinically significant malignancies, necessitating appropriate follow-up. The morphological characteristics observed on CT—such as size, density, and enhancement patterns—can guide initial risk stratification, but ultrasound and fine-needle aspiration cytology (FNAC) remain the gold standards for definitive evaluation [2,4].
Despite the potential clinical implications, reporting practices for ITNs vary significantly among radiology subspecialties, leading to inconsistencies in documentation and follow-up recommendations [3,4]. This variability can result in both over-investigation of benign lesions and missed diagnoses of malignancy. Furthermore, there is a lack of consensus on when to pursue further diagnostic work-up, particularly for small, asymptomatic nodules discovered incidentally [5].
Low-dose chest CT, especially during lung cancer screening, has contributed significantly to the detection of thyroid abnormalities, emphasizing the need for structured reporting and management protocols [5,6]. A comprehensive understanding of ITN characteristics and current reporting practices is therefore essential to guide appropriate clinical decision-making.
This study aims to assess the prevalence and radiological characteristics of incidental thyroid nodules detected on neck and chest CT scans in a tertiary care setting, and to evaluate the patterns of follow-up and diagnostic work-up. The findings are expected to support evidence-based recommendations for the evaluation and management of ITNs in routine radiologic practice.
Study Design and Setting:
This retrospective observational study was conducted in the Department of Radiology, Gandhi Medical College and Hospital, Secunderabad, Telangana.
Study Period:
The study was carried out over an eight-month period from November 2023 to June 2024.
Study Population:
A total of 100 adult patients who underwent neck or chest CT scans for non-thyroid-related indications during the study period were included. Patients with a known history of thyroid disease, thyroid surgery, or previous malignancy involving the thyroid were excluded.
Data Collection:
CT scans performed during the study period were retrieved from the hospital’s radiology information system (RIS) and picture archiving and communication system (PACS). Both contrast-enhanced and non-contrast CT images were reviewed independently by two radiologists to identify and confirm the presence of incidental thyroid nodules (ITNs).
Assessment Parameters:
Additional data including patient demographics (age, gender), recommendations for follow-up imaging or FNAC, and compliance with follow-up were also collected from electronic medical records and radiology reports.
Data Analysis:
The data were entered into Microsoft Excel and analyzed using descriptive statistics. Results were expressed in frequencies, percentages, means, and standard deviations as appropriate.
Ethical Consideration:
Prior permission was taken before starting the study from the concerned authorities. Patient confidentiality was maintained throughout the study by anonymizing data.
A total of 100 patients who underwent neck or chest CT scans for unrelated clinical indications were included in the study. Incidental thyroid nodules (ITNs) were detected in 27 individuals, yielding a prevalence of 27% (Table 1).
Table 1: Demographic Details of Patients
|
Characteristic |
Value |
|
Total Patients |
100 |
|
Patients with Incidental Thyroid Nodules (ITNs) |
27 |
|
Mean Age of ITN Patients (years) |
54.3 ± 12.6 |
|
Gender (Male) |
60 |
|
Gender (Female) |
40 |
The mean age of patients with ITNs was 54.3 ± 12.6 years, and a female predominance was observed among those with nodules (66.7%). The overall study population included 60 males and 40 females.
The size distribution of the detected ITNs showed that the majority of nodules were smaller than 2 cm. Specifically, 11 nodules (40.7%) measured less than 1 cm, 10 nodules (37.0%) measured between 1–2 cm, and 6 nodules (22.3%) were larger than 2 cm (Table 2).
Table 2: Nodule Size Distribution (n = 27)
|
Nodule Size |
Number of Cases |
Percentage (%) |
|
< 1 cm |
11 |
40.7% |
|
1–2 cm |
10 |
37.0% |
|
> 2 cm |
6 |
22.3% |
Regarding the anatomical location, the majority of nodules were found in the right lobe (55.6%), followed by the left lobe (37.0%), and the isthmus (7.4%). In terms of morphology, solid nodules were the most common (59.3%), while mixed cystic-solid and purely cystic nodules accounted for 29.6% and 11.1% respectively (Table 3).
Table 3: Nodule Location and Morphology (n = 27)
|
Parameter |
Number of Cases |
Percentage (%) |
|
Location |
|
|
|
Right Lobe |
15 |
55.6% |
|
Left Lobe |
10 |
37.0% |
|
Isthmus |
2 |
7.4% |
|
Morphology |
|
|
|
Solid |
16 |
59.3% |
|
Mixed Cystic-Solid |
8 |
29.6% |
|
Purely Cystic |
3 |
11.1% |
Follow-up imaging, such as ultrasonography or fine-needle aspiration cytology (FNAC), was recommended in 20 of the 27 patients with ITNs (74.1%), but only 12 patients (44.4%) underwent further evaluation. Among those who completed follow-up, 8 nodules were categorized as benign (Bethesda II), 2 as indeterminate (Bethesda III/IV), and 2 as suspicious/malignant (Bethesda V/VI) (Table 4).
Table 4: Follow-Up and Cytological Findings
|
Category |
Number of Cases |
Percentage (%) |
|
Follow-up Recommended |
20 |
74.1% |
|
Follow-up Completed |
12 |
44.4% |
|
Benign (Bethesda II) |
8 |
66.7% |
|
Indeterminate (Bethesda III/IV) |
2 |
16.7% |
|
Suspicious/Malignant (Bethesda V/VI) |
2 |
16.7% |
The findings of this study demonstrate a 27% prevalence of incidental thyroid nodules (ITNs) on neck and chest CT scans performed for non-thyroid indications, which is consistent with existing literature reporting rates ranging from 16% to 25% [9]. Most of the detected nodules in our study were small (<2 cm), solid in consistency, and predominantly located in the right thyroid lobe. These radiological features are in line with previously reported imaging patterns of ITNs [6,8].
The majority of ITNs are benign and clinically insignificant; however, a small but important subset may represent malignancy. In our study, 16.7% of nodules that underwent further evaluation were categorized as suspicious or malignant, underscoring the importance of risk-based follow-up. Similar malignancy rates in imaging-detected nodules have been reported in prior studies, highlighting the need for vigilance in their assessment [8,10].
Despite follow-up being recommended in over 70% of cases, only 44.4% of patients complied with additional imaging or cytological evaluation. This low follow-up adherence mirrors findings from other retrospective audits and raises concerns about missed opportunities for early diagnosis [7,11]. Various factors, including lack of patient awareness, unclear referral pathways, and variable reporting practices among radiologists, may contribute to this gap [6,10].
The integration of standardized reporting frameworks, such as TI-RADS, and improved interdisciplinary communication have been shown to optimize the management of ITNs and reduce unnecessary interventions [12]. Moreover, structured CT reporting, especially during routine and low-dose chest scans, has been emphasized as an essential step in enhancing clinical outcomes [5,11].
Incidental thyroid nodules are frequently identified on neck and chest CT scans performed for non-thyroid indications, with a prevalence of 27% in our study. Most nodules were small, solid, and located in the right lobe. Although the majority are likely benign, a significant proportion may warrant further evaluation due to potential malignancy. However, suboptimal follow-up rates indicate the need for better awareness and adherence to recommended diagnostic pathways. Implementing standardized reporting systems and clear communication between radiologists and referring clinicians can enhance the management of ITNs. Early identification and risk-based evaluation are essential to ensure timely diagnosis and avoid unnecessary investigations or missed malignancies.
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