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  3. Thyroid Cancer

Thyroid Cancer

NICE guideline [NG230] Thyroid cancer: assessment and management. Published: Dec 2022. NICE guideline [NG145] Thyroid disease: assessment and management. Last updated: Oct 2023.

Thyroid Enlargement / Lump Guidelines

  • 1st line: ultrasound neck - malignancy-suggesting features
  • If ultrasound is abnormal → perform ultrasound-guided final needle aspiration for cytology
  • Further testing (if needed) → core needle biopsy

 

Tumour markers (NICE does not recommend routine measuring for diagnosis, but it's important to learn for exams):

  • Medullary thyroid carcinoma: calcitonin
  • Other types of cancer (papillary, follicular, etc): thyroglobulin

Thyroid Cancer Guidelines

There are 3 main scenarios:
 
Recommended management Indications
Surgery is optional:
  • Active surveillance, or
  • Hemithyroidectomy
  • Solitary microcarcinoma (≤1cm) (T1a) with no node disease and no metastasis
Surgery needed:
  • Hemithyroidectomy, or
  • Total thyroidectomy
  • Multifocal disease, or
  • Thyroid tumour >1cm with no node disease and no metastasis (T2N0M0)
Total thyroidectomy is needed
  • T3 tumour (>4cm limited to the thyroid +/ strap muscles invasion)
  • T4 tuomur (invasion beyond the strap muscles - e.g. subcutaneous soft tissue, larynx, prevertebral fascia, mediastinal vessels)
  • Regional lymph node involvement
  • Distant metastatic disease
  • Adverse pathological features
Compartment-oriented central / lateral neck dissection
  • Structural nodal disease in the lateral and/or central neck
 

As a blunt rule, the following is generally offered to those needing a total thyroidectomy (refer to 3rd row in the table above):
  • Thyrotropin alfa (recombinant human TSH) - to be given before radioactive iodine to maximise radioactive iodine uptake
  • Radioactive iodine - to ablate residual tissue
  • TSH suppression with levothyroxine - to reduce risk of recurrence

Consider external beam radiotherapy if there is macroscopic disease after surgery or local disease that is unlikely to be controlled with radioactive iodine

NICE recommends measuring:
  • Thyroglobulin (detectable thyroglobulin levels suggest residual thyroid tissue or residual or recurrent cancer), and
  • Thyroglobulin antibodies (the presence of thyroglobulin antibodies would affect the measurement of thyroglobulin levels)

References

Author: Adams Lau
Reviewer:
Last edited: 15/08/25