Investigations

Assessment

• do not use calcitonin testing to assess thyroid nodules unless there is a reason to suspect medullary thyroid cancer (MTC), such as a family history or a nodule with an appearance on ultrasound that suggests MTC
• do not routinely measure thyroid peroxidase antibody (TPO)
• consider TPO measurement when interpreting indeterminate cytopathology

Offer ultrasound to image palpable thyroid enlargement or focal nodularity in adults, children and young people with normal thyroid function if malignancy is suspected.

Greyscale ultrasound with an established system should be offered for grading ultrasound appearance as the initial diagnostic test when investigating thyroid nodules for malignancy

Consider ultrasound of incidental findings on imaging if clinical factors suggest malignancy as a possibility.

When making decisions about whether to offer fine needle aspiration cytology, use an established system for grading ultrasound appearance that takes into account:

• echogenicity
• microcalcifications
• border
• shape in transverse plane
• internal vascularity
• lymphadenopathy

Use ultrasound guidance when performing fine needle aspiration cytology

Radioisotope scans

• do not routinely use radioisotope scans for the initial diagnosis of thyroid cancer

Imaging for further staging

• do not routinely use cross-sectional imaging (CT or MRI) in people with T1 or T2 disease and no other indications
• consider cross-sectional imaging (CT of neck and chest, or MRI of neck and CT of chest) for people with thyroid cancer that is T3 or T4, any N1 or M1 thyroid cancer or other clinical suspicion of metastases

Reference:

• NICE (December 2022). Thyroid cancer: assessment and management