# Thyroid cancer - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Thyroid Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459299/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text THYROID CANCER Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Thyroid Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459299/ Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Most patients present with a noticed neck swelling or an incidentally found thyroid nodule on imaging [neck lump] - A concerning history includes rapid nodule growth with pressure symptoms such as voice hoarseness, difficulty swallowing, breathlessness, or Horner syndrome [breathlessness · difficulty swallowing · hoarseness] - A family history of thyroid cancer, prior childhood head or neck radiation, or systemic symptoms like weight loss and fatigue also raise concern [fatigue · weight loss] - Anaplastic thyroid cancer instead causes a rapidly growing neck mass with quick-onset compressive symptoms, plus fever, weight loss, or loss of appetite [fever · neck lump · poor appetite · weight loss] SIGNS - what you find (1) - A firm, fixed nodule with palpable neck lymph nodes on exam should raise suspicion for cancer TESTS (12) - Thyroid function testing is the recommended first step in evaluating any thyroid nodule - A hyperthyroid patient has a lower malignancy risk and should get a radionuclide uptake scan instead - Biopsy is generally avoided for a hyperfunctioning nodule because these are rarely malignant and biopsy results are often inaccurate - A euthyroid or hypothyroid nodule is evaluated first with a high-resolution thyroid ultrasound - High-risk ultrasound features include growth on prior imaging, a dark appearance, irregular margins, a taller-than-wide shape, microcalcifications, a solid structure, extension beyond the thyroid, and central blood flow - Features suggesting lower risk include a fully cystic nodule, a spongiform pattern, comet-tail shadowing, and blood flow only at the edges - Biopsy accuracy depends heavily on operator and pathologist skill, ranging from 70% to 97%, and 17% to 20% of samples come back insufficient - Biopsy diagnoses papillary cancer well but cannot confirm follicular cancer, which needs final surgical pathology to check for capsular or vascular invasion - A Bethesda Category 1 result is non-diagnostic and calls for repeat biopsy - Bethesda Categories 5 and 6 (suspicious or malignant) usually go straight to surgery - Single-mutation molecular tests like BRAF V600E have 100% specificity but only 50-60% sensitivity for indeterminate nodules - A gene expression classifier has a strong negative predictive value but only about 50% positive predictive value, making it a good rule-out test IF NOT THIS - what else fits (4) - Benign thyroid nodule - Toxic nodular goiter - Primary thyroid lymphoma - Cervical lymphadenopathy Source StatPearls "Thyroid Cancer" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Thyroid cancer requires surgical and oncologic management; the GP's role is to recognise a suspicious thyroid nodule and refer promptly. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Thyroid cancer requires surgical and oncologic management; the GP's role is to recognise a suspicious thyroid nodule and refer promptly. Caution A rapidly enlarging neck mass, hoarseness, difficulty swallowing, neck lymph node swelling, or a fixed hard nodule are all urgent referral triggers. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Specific features that should trigger suspicion of malignancy in a thyroid nodule and prompt referral, beyond generic 'suspicious nodule' RED FLAG - Rapidly enlarging neck mass with airway/aerodigestive compressive symptoms suggests anaplastic thyroid cancer, a much more urgent presentation. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)