In primary care, the management of benign thyroid nodules involves several key steps. Initially, arrange serum thyroid function tests (TFTs) to assess thyroid status, as this helps guide further management and referral decisions NICE CKS. Routine neck or thyroid ultrasound is not recommended in primary care because it may delay diagnosis; however, ultrasound should be considered if malignancy is suspected or if clinical factors suggest it NICE CKS,NICE NG145.
For adults with non-malignant thyroid enlargement and normal thyroid function who have mild or no symptoms, no treatment is offered unless there is breathing difficulty or marked airway narrowing NICE NG145. Monitoring in primary care is appropriate for longstanding, stable nodules without red flags or risk factors for malignancy, and for small (<1 cm), asymptomatic incidental nodules without lymphadenopathy NICE CKS. Repeat thyroid ultrasound and TSH measurement should be considered if malignancy or compression is suspected, or if symptoms worsen or new symptoms such as hoarseness or shortness of breath develop NICE NG145.
For cystic nodules causing compressive symptoms, aspiration is offered, with possible ethanol ablation if fluid re-accumulates NICE NG145. For non-cystic nodules or multinodular goitre with compressive symptoms, consider referral for surgery, radioactive iodine ablation, or percutaneous thermal ablation NICE NG145. Urgent referral to specialists is indicated if there are red flags such as unexplained thyroid lumps, associated hoarseness, lymphadenopathy, rapid growth, or compressive symptoms NICE CKS.