Thyroid Cancer

🧭 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. The key skill is twofold: refer any unexplained thyroid lump on the suspected-cancer (2-week-wait) pathway, 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 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), and in those with risk factors: childhood neck irradiation, a family history of thyroid cancer or a familial syndrome (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.

Source: NICE NG12 · NICE NG230