Synopsis
Assess diffuse enlargement and focal nodules systematically, separate airway and cancer risk from thyroid function, and route ultrasound, scintigraphy and cytology through current UK pathways.
- Goitre means thyroid enlargement and can be diffuse or nodular, euthyroid, hypothyroid or hyperthyroid; structure and function must be assessed separately.
- Most thyroid nodules are benign, but history, examination and structured ultrasound determine which need cytology or specialist surveillance.
- Ask about growth rate, pain, dysphagia, dyspnoea, positional symptoms, voice change, radiation exposure, family syndromes and previous thyroid disease.
Key red flags
Rapid or progressive growth, hard fixation, suspicious cervical nodes, persistent unexplained hoarseness, prior neck irradiation or a relevant familial syndrome should accelerate specialist and cancer-pathway assessment.
Investigation priorities
Determine whether the structural lesion is euthyroid, hypoactive or autonomous.
Management branches
Stridor, rapid expansion, positional respiratory compromise or venous congestion is present.
- Keep the patient in the safest tolerated position, assess ABCDE and summon senior anaesthesia and ENT before airway deterioration makes intervention more difficult.
- Use urgent cross-sectional imaging only when the airway is sufficiently stable, with endoscopic assessment and critical-care monitoring directed by the specialist team.
Key medicines
Levothyroxine after definitive hypothyroid treatmentUse an individual once-daily replacement regimen after total thyroidectomy or ablative treatment, selected by age, weight, pregnancy and cardiac risk and titrated against the appropriate TSH target.