Published 13 March 2009, doi:10.1136/bmj.b733
Cite this as: BMJ 2009;338:b733

Clinical Review

Investigating the thyroid nodule

H M Mehanna, director1, A Jain, clinical research fellow1, R P Morton, professor, ENT2, J Watkinson, consultant, ENT3, A Shaha, professor4

1 Institute of Head and Neck Studies and Education, University Hospital, Coventry CV2 2DX , 2 Head and Neck surgery, Counties Manukau District Health Board ENT, Manukau Super Clinic, Manukau, Papakura, Franklin, New Zealand, 3 Head and Neck surgery, Department of Otorhinolaryngology Head and Neck Surgery, University Hospital, Birmingham, United Kingdom, 4 Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York

Correspondence to: H M Mehanna, Consultant Head and Neck Surgeon, and Honorary Associate Clinical Professor, Director, Institute of Head and Neck Studies and Education, University Hospitals Coventry, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom Hisham.Mehanna@uhcw.nhs.uk

The first 150 words of the full text of this article appear below.


Thyroid nodules are common, but only about 5% are malignant
The risk of malignancy is similar for solitary nodules and multinodular goitres
Urgent referral to secondary care is necessary only if the nodule is growing rapidly (over few weeks) or associated with stridor, hoarseness, or cervical lymphadenopathy
Needle aspiration biopsy is the most accurate method of investigation. Its accuracy is improved by ultrasound guidance. Ultrasonography can also add useful information and can improve accuracy.
Management depends mainly on the results of needle aspiration but should also take into consideration the clinical and ultrasound features


Thyroid nodules are common: 4-7% of the adults have a palpable nodule, and up to 50-70% will have nodules on high definition ultrasonography, which may cause considerable concern to patients. In this article, we present an evidence based guide to investigating and managing thyroid nodules and we discuss the myths about nodules. Where relevant, we also . . . [Full text of this article]

Box 2 How to do a fine needle aspiration6

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