Head and Neck A16


Thyroid conditions

The degree of escalation of management for thyroid lumps presenting in primary care depends on the clinical presentation and presence or absence of concerning features. 

  • Immediate hospital admission for patients with symptoms & signs of airway compromise, such as severe stridor
  • Urgent referral (2-week rule) to a thyroid surgeon or endocrinologist for the following patient groups:
    • Unexplained hoarseness or voice changes associated with a goitre
    • Lymphadenopathy associated with a thyroid lump (usually deep cervical or supraclavicular region)
    • Rapidly enlarging painless thyroid mass increasing in size over a period of weeks
    • Child with thyroid nodule
  • Non-urgent referral for the following patient groups:
    • Patients with thyroid nodules with abnormal thyroid function tests (TFTs)
    • Sudden-onset pain in a thyroid lump (bleeding into a benign thyroid cyst)
    • Newly presenting thyroid lump with no concerning features
  • Manage in primary care for patients with a thyroid nodule or goitre that has not changed for several years and without any of the following concerning features:
    • Adult patient with history of neck irradiation
    • Family history of thyroid cancer
    • Palpable cervical lymphadenopathy
    • Stridor or voice changes

Correct Answer: