GPAtlas🧭 When to suspect
Thyroid cancer is uncommon – roughly 1% of all cancers, with around 3,800 new UK cases a year and a rising incidence. It is about three times more common in women, with a peak in women aged 35–39 and in men aged 65–70.
The great majority present with a single, often painless thyroid lump (nodule) or a diffuse neck swelling (goitre).
The reassuring background is that most thyroid nodules are benign – only a small minority prove malignant – but the primary-care task is to make sure the sinister minority is not missed.
Refer any unexplained thyroid lump on the suspected cancer pathway (previously the two-week wait), and recognise the rare airway emergency. A rapidly enlarging, hard goitre causing stridor – think anaplastic carcinoma or a large compressive goitre – needs same-day admission, not a routine referral.
Check thyroid function in parallel, but remember that a normal thyroid-stimulating hormone (TSH) never excludes cancer – most thyroid cancers are euthyroid.
Raise suspicion particularly with:
• Rapid growth
• A hard or fixed nodule
• Cervical lymphadenopathy
• Hoarseness or compressive symptoms (dysphagia, stridor)
• Risk factors: childhood neck irradiation, a family history of thyroid cancer or a familial syndrome (multiple endocrine neoplasia type 2 [MEN2], familial adenomatous polyposis)
A new nodule at the extremes of age (a child, or an adult over 65) also warrants heightened concern. A rapidly enlarging mass on a background of Hashimoto's should also raise the possibility of primary thyroid lymphoma.
| Type | Key features | Prognosis/notes |
|---|---|---|
| Papillary (~80–85%) | • Commonest • Younger adults and women • Spreads via cervical lymphatics • Often multifocal |
• Excellent prognosis • Linked to childhood radiation |
| Follicular (~10%) | • Older patients • Haematogenous spread (lung, bone) |
• Good prognosis • Fine-needle aspiration cytology (FNAC) cannot distinguish from adenoma – needs histology |
| Medullary (~5%) | • Parafollicular C cells • Secretes calcitonin • ~25% familial (MEN2/RET) |
• Variable • The one to genetic-test |
| Anaplastic (~1–2%) | • Elderly • Rapidly enlarging, hard, fixed mass • Airway compromise |
• Aggressive, poor prognosis • Airway emergency |
Source: NICE NG12 · NICE NG230
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