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  • Writer's pictureNalaka de Silva

Thyroid Mass

Updated: Jun 19, 2019

Please note that the following is a general guideline only.


When a patient with a thyroid mass presents,

-The first step is to see if it is goitre or a thyroid nodule.

-The second step is to determine the risk of cancer within

-The third step is to see if the patient is hyperthyroid or not

-Fourth is to determine if there are compressive symptoms- if so URGENT referral

The examination should assist determine the above four features

Investigations should be directed according to the findings.


Is this a long-standing mass, is the whole thyroid large or a nodule?

Is it an endemic goitre

Is it a toxic goitre

Is this a nodule the patient is presenting with

Is there is a risk of cancer

Extremes in age (very young or older)

Radiation exposure

Family Hx of thyroid cancer

Hyper or Hypothyroid symptoms

Rare for a nodule to be cancerous if hyper hyperfunctioning

Are the symptoms of acute onset or a longer standing

Are there compressive symptoms


Swallowing? if significant URGENT referral


First confirm its the thyroid (moves with swallowing)

Determine if this is a goiter or a nodule

look for cancer

Any hard masses- Hard= risk of cancer (individual nodule or within a goitre)

Any neck nodes (nodes= cancer)

look for compressive features

if venous congestion positive Pemberton's test

Stridor-URGENT Referral

Look for hyperthyroid features

Look for hypothyroid features


-The first line of test:TFT- Hyperthyroid

If hyperthyroid determine the cause (Graves, Toxic nodular goiter/ thyroiditis)

Endocrine review

Anti thyroid medications

-If hyperthyroid also do TC99

what we want to know it a hot nodule (low risk) or a hot gland with a cold nodule (High risk of cancer)

If cold nodule need US and FNA (as below)

If Euthyroid and a nodule/ or a euthyroid goitre

US-? suspicious features in nodules (i.e. calcification etc)

if so FNA the risky nodules

Treatment Outline

If US FNA says benign- 95% it benign, need to repeat US +/- FNA in 6 months

If FNA is cancer- Total thyroidectomy plus post op radioactive I if high risk

If inconclusive / follicular cells need hemithyroid- if cancer completion total T

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