Thyroid Nodules
Thyroid nodules, particularly when solitary and clinically obvious, should be investigated, as they carry a small but significant malignant potential (up to 10%). Please check TFTs and refer to the thyroid nodule clinic. The usual presentation is that of a palpable lump in the neck, which moves on swallowing, and there may be no other symptoms or signs.
Hyper- or hypo-thyroidism associated with a nodular goitre are unlikely to be due to thyroid cancer: these patients should be referred to a general endocrine clinic.
Initiation of other investigations (such as ultrasound scanning or autoantibodies) are unnecessary and may cause delay in making the diagnosis of cancer – further tests will be arranged in the clinic.
Thyroid Cancer
- Should be considered with the finding of a thyroid nodule, especially when solitary & clinically obvious and / or rapidly increasing in size.
- Is rare, representing only about 1% of all cancers – around 320 p.a. in Scotland
- Can occur at any age and is more common in females
- Commoner with family history of endocrine tumours
- Is commoner in those with a history of neck irradiation
- Has an overall 10-year survival rate for differentiated thyroid carcinoma of 80 – 90%.
- Patients develop local or regional recurrences in 5-20% and 10 – 15% develop distant metastases.
Please see the Scottish Cancer Referral Guidelines for further detail and USC indications below.
C.M – 27-03-26
Immediate (same day) referrals:
Patients with stridor associated with a thyroid swelling should be referred as a same day emergency.
Urgent referrals for suspected cancer:
Refer a person with a thyroid nodule, and one or more of the following features to the Neck Lump clinic as USC:
- A nodule rapidly increasing in size
- Associated unexplained hoarseness
- Associated cervical lymphadenopathy
- Previous neck irradiation
- Family history of endocrine tumours
- Anyone aged 16 years or under.
Please refer to the Thyroid Nodule Clinic:
Euthyroid patients with a goitre.
- Patients with thyroid lumps including:
- Those with a thyroid lump that has newly presented or has been increasing in size over time.
- Those with a history of sudden onset of pain in a thyroid lump (likely to have bled into a benign thyroid cyst)
