This site is intended for healthcare professionals

Sign in
Go to /sign-in page

You can view 5 more pages before signing in

Assessment of thyroid nodule

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinical evaluation of patients with thyroid nodules

NICE suggest to only consider ultrasound for adults with thyrotoxicosis if they have a palpable thyroid nodule (1)

When considering the symptomatology associated with a thyroid nodule then the onset and rate of progression of symptoms are important in terms of risk of thyroid cancer

  • persistent hoarseness and rapidly growing thyroid nodules more likely to indicate a malignant cause

Assessment of symptomatology associated with a thyroid nodule:


Possible symptoms related to thyroid nodules include:

  • a palpable neck mass
  • anterior neck pain
  • globus sensation
  • dysphagia
  • dyspnoea
  • dysphonia/ hoarseness

Swallowing complaints are common but non-specific

  • more than 50% associated with laryngopharyngeal reflux (2)

Laboratory testing

TFTs - to rule out hyperthyroidism

  • most hyperfunctioning thyroid nodules are benign

Calcitonin

  • controversy exists about the benefit of routine measurement of serum calcitonin (2)
    • specificity of an elevated serum calcitonin (>100 pg/mL) for diagnosis of medullary thyroid cancer (MTC) is improved with pentagastrin stimulation; however, pentagastrin is no longer available in the US and supply is limited in Europe
    • some authors consider routine calcitonin measurement of uncertain benefit during initial thyroid nodule work-up (2)

Assessment of thyroid cancer risk


Need for thyroid biopsy based on clinical, laboratory, and ultrasound findings

The British Thyroid Association categories based on presence of different ultrasound features (composition, vascularity, echogenicity, shape, calcifications, lymph nodes, margins):

U1- normal

Do not need biopsy, unless patient has statistically high risk of malignancy

U2 - benign

Do not need biopsy, unless patient has statistically high risk of malignancy

U3 - indeterminate/equivocal

Thyroid biopsy recommended

U4 - suspicious

Thyroid biopsy recommended

U4 - malignant

Thyroid biopsy recommended

If biopsy undertaken then next management step (whether surgical intervention or observation) based on

  • the FNA result
  • molecular markers and/or repeat FNA
  • individual patient's preferences and context

Reference:

  • NICE (November 2019). Thyroid disease: assessment and management
  • Ospina NS et al. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment.BMJ 2020;368:l667.

Related pages

Create an account to add page annotations

Create a free account

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.