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Thyroid enlargement / thyroid nodules


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • In the setting of abnormal thyroid function
    • The following conditions are to be referred if accompanied with normal thyroid function:
      • unexplained hoarseness or voice changes associated with a goitre
      • goitre associated with symptomatic airway narrowing
      • cervical lymphadenopathy associated with a thyroid mass (usually deep cervical or supraclavicular region)
      • a rapidly enlarging thyroid mass over a period of weeks (a rare presentation of thyroid cancer and usually associated with anaplastic thyroid cancer or thyroid lymphoma)
      • lymphadenopathy
      • stridor, venous congestion on elevation of upper limbs
      • dominant nodule >4cm in size
      • abnormal cytology
  • Category 2
    (appointment within 90 calendar days)
    • Diffuse goitre, multi-nodular goitre or solitary nodule (<4cm in size)
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Previous imaging or cytology
  • TFTs – free T4, T3 and TSH
  • USS, CXR

3. Additional referral information Useful for processing the referral

  • Thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
  • CT neck without contrast if compressive symptoms
  • Consider FNAC according to TI-RADS score recommendation [TI-RADS calculator]

4. Request

Last updated: 13 June 2023