What are the key clinical features that suggest a thyroid nodule may b

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

The key clinical features that suggest a thyroid nodule may be malignant include specific symptoms, physical findings, and patient characteristics .

Unexplained hoarseness or voice change associated with a thyroid mass . This symptom may suggest tumour invasion of the recurrent laryngeal nerve .
Cervical or supraclavicular lymphadenopathy associated with a thyroid mass . The presence of cervical lymph nodes ipsilateral to the thyroid nodule may indicate thyroid malignancy .
Sudden onset of a rapidly expanding painless thyroid mass, significantly increasing in size over days and weeks . This can be a rare presentation of anaplastic thyroid cancer or thyroid lymphoma .
Associated compressive symptoms, such as breathlessness or dysphagia .
The presence of other red flags or risk factors for malignancy .
In children, thyroid nodules are more likely to be malignant than in adults .
A family history or specific ultrasound appearance suggesting medullary thyroid cancer (MTC) .

What are the key clinical features that suggest a thyroid nodule may be malignant?