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Neck lump - Management
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How should I manage a thyroid lump?
- Admit to hospital immediately if the person has symptoms of tracheal compression, such as severe stridor at rest.
- Refer urgently (to a thyroid nodule clinic, a surgeon, or an endocrinologist, depending on local services) if the person has a thyroid swelling and any of the following:
- A solitary nodule increasing in size.
- A history of neck irradiation.
- Thyroid nodule or goitre in a child or teenager.
- A family history of an endocrine tumour.
- Unexplained hoarseness or voice changes.
- Cervical lymphadenopathy (usually deep cervical or supraclavicular).
- Age 65 years or older.
- Enlargement of a painless thyroid mass over a period of weeks (may be indicative of thyroid cancer).
- Refer non-urgently if the person has no urgent referral criteria and:
- A thyroid nodule or goitre with hyperthyroidism or hypothyroidism (refer to an endocrinologist — thyroid cancer is very unlikely). Admission to hospital may be required if the person has severe symptoms.
- For more information on managing people with abnormal thyroid function tests while they are awaiting referral, see the CKS topics on Hyperthyroidism and Hypothyroidism.
- A thyroid swelling and normal thyroid function tests.
- A lump that is newly presenting or has been increasing in size over a period of months.
- Sudden onset of pain in a thyroid lump (usually due to bleeding into a benign thyroid cyst).
- Referral is not required for people with:
- A history of a nodule or goitre that has not changed for years, and who have no other worrying features (for example an adult with no history of neck irradiation, no family history of thyroid cancer, and no palpable cervical lymphadenopathy).
- A non-palpable asymptomatic nodule less than 1 cm in diameter, discovered coincidentally by imaging of the neck without other worrying clinical features or radiological signs of suspicion.
Basis for recommendation
People who require referral
- The recommendations regarding admission and referral of people with thyroid lumps are based on expert opinion in guidelines from the National Institute for Health and Clinical Excellence [NICE, 2005a] and the British Thyroid Association [BTA, 2007].
People who do not require referral
- The information on who does not require referral is based on expert opinion in a guideline from the British Thyroid Association [BTA, 2007].
- In general, nodules measuring more than 1 cm in diameter are more likely to be clinically significant cancers. Nodules less than 1 cm in diameter that require evaluation usually have associated features which are urgent referral criteria. It is unusual that a 1 cm nodule without other worrying features causes morbidity or mortality. The American Thyroid Association suggests that to treat all less than 1 cm in diameter nodules may cause more harm than good and has an unfavourable cost-benefit ratio [American Thyroid Association, 2009].
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