Guidelines for seeing a thyroid specialist

This page tells you about the guidelines that GPs in the UK have to help them refer the right people to specialists for thyroid cancer tests. There is information about

A quick guide to what's on this page
About UK guidelines
What to bear in mind
Guidelines for urgent referral
Guidelines for immediate referral

Guidelines for seeing a thyroid specialist

It can be very difficult for GPs to decide who may have a suspected cancer and who has something much less serious. But there are particular symptoms that mean your GP should refer you to a specialist straight away. If you have a type of noisy breathing called stridor which can be caused by swelling of your thyroid you should be seen straight away. The National Institute for Health and Clinical Excellence (NICE) says that you should see a specialist within 2 weeks if you have a thyroid lump or swelling and any of the following

The thyroid lump or nodule is growing in size
Previous radiotherapy to the neck area
A history of an endocrine tumour (such as thyroid cancer) in the family
Hoarseness or voice changes that your GP can't explain
Other lumps in your neck, that could be enlarged lymph nodes
You are aged 65 or over, or you are a child who has not yet gone through puberty

If you have a thyroid lump or swelling but don't have any of the features listed above, your GP should take blood tests to see how your thyroid is working. Your GP may send you to see a specialist, but not urgently.

If you think your GP is not taking your symptoms as seriously as you think they should, you could print out this page and take it to your appointment.

CR PDF Icon You can view and print the quick guides for all the pages in the about thyroid cancer section.

Thyroid swellings are very common and most of them are benign (non cancerous). It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious that will go away on its own.

With many symptoms, it is perfectly right that your GP should ask you to wait and see if they get better. If GPs sent everyone to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

If you have particular symptoms, your GP should refer you to a specialist straight away. Government guidelines help GPs decide which patients need to be seen urgently by a specialist. The guidelines were reviewed by The National Institute for Health and Clinical Excellence (NICE) in 2005. They include specific recommendations on referrals for people with suspected thyroid cancer. In Scotland, similar guidelines have been produced by The Scottish Intercollegiate Guidelines Network (SIGN).

While reading these guidelines, it is important to remember that

Thyroid lumps are very common but only 1 in 20 are cancer
Thyroid cancer is rare and there are about 2,100 cases per year in the UK
Thyroid cancer is more common in women and almost 3 times more women are diagnosed than men

The guidelines say that you should see a specialist urgently (within two weeks) if you have a thyroid lump or swelling and any of the following

The thyroid lump or nodule is growing in size
Previous radiotherapy to the neck area
A history of an endocrine tumour (such as thyroid cancer) in the family
Hoarseness or voice changes that your GP can't explain
Other lumps in your neck, that could be enlarged lymph nodes
You are aged 65 or over or you are a child who has not yet gone through puberty

If you have a thyroid lump or swelling but don't have noisy breathing or any of the features listed above, your GP should take blood tests to see how your thyroid is working. These blood tests will show whether you have a normal, over active, or under active thyroid. If your thyroid is over or under active, your GP may send you to see a specialist, but not urgently. There is more about the symptoms of an under or overactive thyroid in the about thyroid cancer section of CancerHelp UK. If you have a thyroid lump (or goitre) and your thyroid is working normally, your GP should also refer you to a specialist but not urgently.

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

The guidelines say that if you have a type of noisy breathing called stridor you should be referred to hospital and seen by a specialist within a few hours. Stridor is a rasping noise when you breathe and is a sign that your airway (windpipe) is blocked in some way. Swelling of your thyroid can cause stridor but this is very rare.