Endocrine Society

View all recommendations from this society

Released October 16, 2013*; updated June 3, 2022

Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. However, thyroid vascularity assessed by color flow doppler in patients with overt hyperthyroidism (elevated free T4 and T3 and suppressed TSH) may help distinguish Graves’ hyperthyroidism and toxic nodular goiter from a destructive thyroiditis (painless, painful, or drug induced).

Thyroid ultrasound is used to identify and characterize thyroid nodules. Thyroid ultrasound is not part of the routine evaluation of hypothyroidism unless the patient also has a large goiter or a lumpy thyroid. Incidentally discovered thyroid nodules are common. Overzealous use of ultrasound will frequently identify nodules that are unrelated to the abnormal thyroid function. This may divert the clinical evaluation to assess the nodules, rather than the thyroid dysfunction. Thyrotoxic patients with nodules may also benefit from imaging. For these patients, a thyroid scan is used to assess the possibility of focal autonomy in a thyroid nodule, and correlated with the ultrasound findings. In some centers assessment of thyroid artery blood flow by doppler may be used to help distinguish Graves’ disease from a destructive thyroiditis.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

Members of the Endocrine Society (Society) along with representatives of the American Association of Clinical Endocrinologists (AACE)* formed a joint task force to identify tests or procedures which should only be used in specific circumstances. The task force identified several items for possible inclusion. Subsequent discussions compared the evidence supporting each item, the value of the recommendation to practitioners and the potential for cost savings. Members of the Society’s Clinical Affairs Core Committee and AACE leadership also reviewed the initial list. Using the above criteria, the task force voted for their top five recommendations from the original list. The Society’s Council and AACE’s Board of Directors approved the final list for submission to the Choosing Wisely® campaign.

The Endocrine Society disclosure and conflict of interest policies can be found at www.endocrine.org.

*The American Association of Clinical Endocrinologists withdrew from the Choosing Wisely campaign on May 26, 2015.


Jacqueline Jonklaas, Antonio C. Bianco, Andrew J. Bauer, Kenneth D. Burman, Anne R. Cappola, Francesco S. Celi, David S. Cooper, Brian W. Kim, Robin P. Peeters, M. Sara Rosenthal, and Anna M. Sawka. Guidelines for the treatment of hypothyroidism. Thyroid 2014; 24:1670-1751.

Douglas S. Ross, Henry B. Burch, David S. Cooper, M. Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A. Rivkees, Mary Samuels, Julie Ann Sosa, Marius N. Stan, and Martin A. Walter. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26:1343-1421.