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Jonathan Hughes | Hemel Hempstead

Thyroid Specialist London

Thyroid Lumps and Nodules: Assessment and Diagnosis

Medically reviewed by Mr Jonathan Hughes PhD FRCS, Consultant ENT, Head and Neck and Thyroid Surgeon. GMC 4702289. Last reviewed October 2026.

Finding a lump in your neck is worrying, and most people want answers quickly. Mr Jonathan Hughes is a thyroid lump specialist in London. He sees adults who have noticed a swelling themselves, and those who have been told about a nodule after a scan for something else. Thyroid disease is one of his specialist interests. He’ll examine you, carry out the right tests and explain what the results mean for you.

What is a thyroid lump?

Your thyroid is a butterfly-shaped gland at the front of your neck, just below the Adam’s apple. A thyroid lump, often called a thyroid nodule, is an area of tissue that grows differently from the rest of the gland. Some are solid and some are filled with fluid (a thyroid cyst).

Thyroid nodules are common, and most of them are harmless. NHS patient information puts the figure at about 95% benign. You might have a single nodule or several. When the whole gland is enlarged it’s called a goitre, and a goitre with several nodules is called a multinodular goitre. Mr Hughes sees patients with single nodules, cysts and goitres, so you don’t need a separate goitre specialist.

Thyroid lump symptoms

Many thyroid nodules cause no symptoms and are only found by chance. When they do, you might notice:

  • a lump or swelling at the front of your neck that moves when you swallow
  • a feeling of pressure or tightness in your throat
  • difficulty swallowing
  • a hoarse or changed voice
  • discomfort lying flat, if the lump is large

Some nodules make too much thyroid hormone. That can cause weight loss, a racing heart or feeling hot and shaky.

Not every lump in the neck comes from the thyroid. If you’re not sure, our neck lumps page covers the other common causes.

See your GP or a specialist promptly if the lump is growing quickly, feels hard or fixed, or comes with a hoarse voice that doesn’t settle.

Thyroid nodule diagnosis: how lumps are investigated

The aim is to find out what the lump is. Investigation usually follows these steps.

Consultation and examination

Mr Hughes will ask about your symptoms, your medical history and any family history of thyroid problems. Then he’ll examine your neck.

Blood tests

Thyroid function tests show whether your thyroid is making the right amount of hormone.

Thyroid ultrasound

Mr Hughes carries out thyroid ultrasound scans himself, so you don’t need a separate appointment with a radiologist. The scan shows the size, shape and structure of the nodule and checks the lymph glands around it. In the UK, nodules are graded U1 to U5 on ultrasound. The grade tells you whether a nodule looks reassuring or needs a closer look.

Thyroid nodule biopsy (fine needle aspiration)

If the ultrasound shows features that need checking, a thin needle takes a small sample of cells from the nodule, guided by the scan. Mr Hughes does this himself, and it can usually be done in the same appointment as your ultrasound. A pathologist then examines the sample under a microscope.

Most people get a clear answer from these tests. Sometimes the result is uncertain, and Mr Hughes will talk you through the next step.

Is my thyroid lump cancerous?

Most thyroid lumps are not cancer. The risk is higher if you’ve had radiation to your head or neck, if thyroid cancer runs in your family, or if the lump is growing fast or has changed your voice. Ultrasound and biopsy are how the question gets answered, so please don’t assume the worst before you’ve had them. Our guide on how to tell if a thyroid lump is cancerous goes into more detail.

What happens after diagnosis?

A benign thyroid nodule often needs nothing more than a check-up scan to make sure they aren’t changing. If a lump is large, causing symptoms or the results are uncertain, Mr Hughes may recommend removing part or all of the gland. Our thyroid lump removal page explains the operation and recovery.

Your thyroid lump specialist in London

Mr Hughes is a consultant ENT, head and neck and thyroid surgeon. He holds NHS posts at University College London Hospitals and the Royal Free London. He completed two Royal College of Surgeons of England accredited fellowships and has spent 15 years working in otolaryngology in the UK and the USA. Complex cases are discussed with a multidisciplinary team, and he sees private patients in Central London, North London and the Chilterns. Read Mr Hughes’ full profile

Why I have I got thyroid lumps?

One cause of a thyroid lump is thyroid cancer. Additionally, goitre, an diffuse enlargement of the thyroid gland, can also result in thyroid swelling. While goitre itself is rarely a serious medical problem, it can lead to complications if left untreated.

What sort of investigation methods are used for thyroid lumps?

A thorough clinical examination of the lump will take place. Ultrasound imaging, which allows for a detailed view of the thyroid gland, surrouding lymph glands and any other abnormalities is often used. This non-invasive procedure uses sound waves to create images of the gland, providing valuable information about the size, shape, and composition of the lump. If the ultrasound reveals any suspicious features, further investigation may be needed. In such cases, a fine needle aspiration (FNA) cytology (like a biopsy) may be recommended. This procedure involves a thin needle being used to extract a small cellular sample from the lump for further analysis. The sample is then examined under a microscope to determine if it is benign or cancerous.

What sort of treatments are available for thyroid lumps?

The treatment required for thyroid lumps depends on various factors such as the size, location, and nature of the lump. A thyroidectomy may be recommended if the lump is potentially cancerous. A potential additional treatment after surgery is radioiodine ablation, which involves taking radioactive iodine orally to destroy any residual thyroid tissue.

Will I definitely need surgery?

No. Many thyroid lumps only need monitoring, particularly when tests confirm they are benign. Surgery is usually considered when a lump is causing symptoms, is growing, is affecting breathing or swallowing, or when there is a concern it could be cancerous. Mr Hughes will talk through whether any treatment is needed, and if it is, which option fits your situation.

How often are thyroid lumps cancerous?

The majority of thyroid nodules are benign, but a small percentage can be cancerous. The risk of a thyroid lump being cancerous increases with certain factors such as age, family history of thyroid cancer, radiation exposure, and the presence of other symptoms. If a thyroid lump is suspected to be cancerous, further investigation is required, including imaging tests, blood tests, and possibly a biopsy.

Will I need medication for life after thyroid surgery?

It depends on how much of the thyroid is removed. If the whole gland is taken out, you will need thyroid hormone replacement, usually one tablet a day, to do the job the gland normally does. If only part is removed, the remaining thyroid can often produce enough hormone on its own. Mr Hughes will go through what to expect before any surgery.

Do thyroid lumps go away on their own?

Some fluid-filled (cystic) nodules can shrink by themselves, but most solid lumps do not disappear without treatment. After a lump is removed surgically, it is uncommon for it to come back in the same place, though the rest of the gland may still be monitored over time.