Neck deep

Thyroid nodules require immediate investigation and may need long-term follow-up

Alice, a 54-year-old teacher, presents with a rapidly enlarging, palpable nodule in her neck, which was first noted six months prior to her presentation.

Alice does not smoke, rarely drinks alcohol and undertakes minimal exercise. She reports no known family history of thyroid disease and no previous irradiation.

Alice has never taken the contraceptive pill and takes no regular medications.

Thyroid nodules are common. Most nodules are incidental findings noted on imaging for other medical conditions.

The main concerns regarding thyroid nodules are whether they cause thyroid dysfunction and whether they are malignant.

Most thyroid nodules are benign. Risk factors include: smoking, alcohol consumption, raised insulin growth factor-1 (IGF-1) levels and uterine fibroids. However, use of oral contraceptives and statins may decrease risk.