Thyroid nodule (palpable or found on imaging, multinodular goitre)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Initial tests
Laboratory tests
- TSH (then free T4 ± free T3 as reflex tests if TSH < 0.1 mIU/L or confirmed low)
- Anti-TPO antibodies (if raised TSH confirmed)if neededTSH > 10 mIU/L or a rise confirmed on a second sample: look for an associated autoimmune thyroiditis, with free T4 [2,3].
- Anti-thyroglobulin antibodies (if TSH raised and anti-TPO negative)if neededSecond-line only, when TSH is raised and anti-TPO negative [2,3].
- TSH receptor antibodies (if hyperthyroidism without autonomous nodule)if neededHyperthyroidism not explained by an autonomous nodule on scintigraphy: look for associated Graves' disease [2,3].
- Calcitonin (if context: see the note)if neededPersonal or family history of medullary cancer or MEN 2; nodule with diarrhoea, flushing or lymphadenopathy; suspicious nodule; Bethesda III to VI cytology [2,3,4].
Do not order
- Thyroglobulin: it does not distinguish a benign from a malignant nodule and has no place in the initial tests [2,3].
- Free T4, free T3 or antibodies straight away when TSH is not yet known or is normal: TSH is the only essential measurement, the others are done as reflex tests depending on its result [2,5].
- Routine serum calcium, corrected calcium or PTH for a nodule: not recommended; serum calcium is measured before thyroid surgery [2].
- Calcitonin repeated after a first normal measurement, without genetic predisposition to medullary cancer [2].
- Screening thyroid ultrasound in adults without nodule or symptoms: not recommended, it increases overdiagnosis of small papillary cancers without reducing mortality [2,3].
Before surgery or thermal ablation
Laboratory tests before thyroid surgery or thermal ablation
- Calcitonin
- Serum calcium
After lobectomy for a benign nodule
6 to 8 weeks after lobectomy
- TSH
Sources (13)
- Borson-Chazot F, Borget I, Mathonnet M, Leenhardt L. SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Epidemiology and challenges in the management of thyroid nodules. Ann Endocrinol (Paris). 2022;83(6):378-379.
- Do Cao C, Haissaguerre M, Lussey-Lepoutre C, Donatini G, Raverot V, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Initial work-up for thyroid nodules. Ann Endocrinol (Paris). 2022;83(6):380-388.
- Durante C, Hegedüs L, Czarniecka A, Paschke R, Russ G, Schmitt F, et al. 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. Eur Thyroid J. 2023;12(5):e230067.
- Leboulleux S, Lamartina L, Lecornet Sokol E, Menegaux F, Leenhardt L, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Follow-up: How and how long? Ann Endocrinol (Paris). 2022;83(6):407-414.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1208, 1211 et 1212 (TSH, T4L, T3L), 1484 (anticorps anti-thyroglobuline), 1487 (anticorps anti-TPO), 1488 (anticorps anti-récepteurs de la TSH) et 1132 (calcitonine).
- Thuillier P, Benisvy D, Ansquer C, Corvilain B, Mirallié E, Taïeb D, et al. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: What is the role of functional imaging and isotopic treatment? Ann Endocrinol (Paris). 2022;83(6):401-406.
- Drui D, Briet C, Guerin C, Lugat A, Borson-Chazot F, Grunenwald S. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Thyroid nodules and pregnancy. Ann Endocrinol (Paris). 2022;83(6):435-439.
- Moorthy R, Balasubramanian SP, Farnell K, et al. Evaluation and Management of Thyroid Nodules: A Joint Consensus Statement From the British Thyroid Association (BTA), British Association of Endocrine and Thyroid Surgeons (BAETS) and Collaborating Bodies. Clin Endocrinol (Oxf). 2026;104(6):682-692.
- Kant R, Davis A, Verma V. Thyroid Nodules: Advances in Evaluation and Management. Am Fam Physician. 2020;102(5):298-304.
- Lee EK, Park YJ, Jung CK, Na DG. A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules. Endocrinol Metab (Seoul). 2024;39(1):61-72.
- National Institute for Health and Care Excellence (NICE). Thyroid cancer: assessment and management. NICE guideline NG230, publiée le 19 décembre 2022 (recommandations 1.2.1 à 1.2.3 et leur justification).
- US Preventive Services Task Force. Thyroid Cancer: Screening. Final Recommendation Statement, 9 mai 2017 (recommandation D).
- National Institute for Health and Care Excellence (NICE). Thyroid disease: assessment and management. NICE guideline NG145, publiée le 20 novembre 2019, mise à jour le 12 octobre 2023 (recommandations 1.7.8 et 1.9.1).