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Head/neck cancer - suspected - Management
Thyroid cancer
- In patients presenting with symptoms of tracheal compression including stridor due to thyroid swelling, immediate referral should be made (D).
- In patients presenting with a thyroid swelling associated with any of the following, an urgent referral should be made: (D)
- A solitary nodule increasing in size
- A history of neck irradiation
- A family history of an endocrine tumour
- Unexplained hoarseness or voice changes
- Cervical lymphadenopathy
- Very young (pre-pubertal) patients
- Patients 65 years of age and older
- In patients with a thyroid swelling without stridor or any of the features listed above, the primary healthcare professional should request thyroid function tests. Patients with hyper- or hypothyroidism and an associated goitre are very unlikely to have thyroid cancer and could be referred, non-urgently, to an endocrinologist. Those with goitre and normal thyroid function tests who do not have any of the features listed above should be referred non-urgently (D).
- Initiation of other investigations by the primary healthcare professional, such as ultrasonography or isotope scanning, is likely to result in unnecessary delay and is not recommended (D).
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