Thyroid
nodulesInvestigating the thyroid nodule
- Thyroid nodules are common, but only about 5% are malignant
- The risk of malignancy is similar for solitary nodules and multinodular goitres
- Urgent referral to secondary care is necessary only if the nodule is growing rapidly (over few weeks) or associated with stridor, hoarseness, or cervical lymphadenopathy
- Needle aspiration biopsy is the most accurate method of investigation. Its accuracy is improved by ultrasound guidance. Ultrasonography can also add useful information and can improve accuracy.
- Management depends mainly on the results of needle aspiration but should also take into consideration the clinical and ultrasound features
Red flag" features: worrying signs and symptoms in a patient with a thyroid nodule
- Family history of thyroid cancer
- History of previous irradiation or exposure to high environmental radiation
- Child with a thyroid nodule
- Unexplained hoarseness or stridor associated with goitre
- Painless thyroid mass enlarging rapidly over a period of a few weeks
- Palpable cervical lymphadenopathy
- Insidious or persistent pain lasting for several weeks