Before attributing throat symptoms to a thyroid nodule, ask specifically about breathlessness and orthopnoea, which were linked to benefit from surgery. Then look for the common mimics: heartburn and throat clearing for reflux, and voice strain or tightness for laryngeal muscle tension. Flexible laryngoscopy and a nodule volume on ultrasound make the decision clearer.
- Ask about breathlessness, including lying flat; these symptoms favour true compression.
- Ask about heartburn, throat clearing and voice strain to screen for reflux and muscle tension.
- Calculate nodule or goitre volume on ultrasound rather than relying on the largest diameter.
- Perform flexible laryngoscopy before listing for surgery for compressive symptoms.
Why it matters
Symptom pattern separates patients who will benefit from thyroidectomy from those who will not.
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