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Thyroid Enlargement Referral Guidelines

An enlarged thyroid, or goiter, can usually be painless but have adverse effects on the body. A large goiter can cause difficulty breathing or swallowing. The thyroid gland produces two main hormones – thyroxine (T-4) and triiodothyronine(T-3), which circulate in the bloodstream and regulate metabolism. An enlarged thyroid may be regulating hormones properly, or it may produce too much or too little. Other common causes of an enlarged thyroid could include Graves’ disease or Hashimoto’s disease.

View our flow chart (PDF).

Initial Evaluation
- Thyroid enlargement – swelling at the base of the neck, may be obvious
- Patient may complain of: tightness in the throat, coughing, hoarseness, difficulty swallowing or breathing
Initial Management
- Asymmetrical enlargement or suspect nodule – request a thyroid ultrasound
- TSH, Free T4, Thyroid Peroxidase antibody (TPO) – test requested
- If thyroid ultrasound shows a nodule, refer to the endocrinology thyroid nodule and thyroid cancer clinic. Expedited appointment will be given.
- If TSH >5 or <0.1, refer to endocrinologist
- If TSH >30 or Free T4>2, an urgent appointment is necessary
- If tests are free, no referral is needed. Check again in six months for consistent results.
Fax lab results to 202-476-4095 with contact information for the family. Our office will contact the family to set up the appointment.
If an expedited appointment is required, please call our doctor on call at 202-476-2121.
All patients with thyroid nodule evaluation will be given expedited appointment in the thyroid nodule and cancer clinic. A CD of the thyroid ultrasound must be provided at the time of the evaluation. For all inquiries regarding the thyroid nodule and thyroid cancer clinic, please call 202-476-2121.

Coronavirus Update:What patients and families need to know

Thyroid Enlargement Referral Guidelines

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