Thyroid nodules, goitre and thyroid cancer — OSCE

Objectives

1. Explain that most paediatric thyroid nodules are benign but that childhood risk is higher than adult risk, justifying a structured pathway. [1] [5]
2. Outline the ultrasound (TI-RADS) and FNA (Bethesda) steps in plain language. [1] [2]
3. Reassure without over-promising, and avoid promising surgery or radioiodine before the diagnosis is complete. [1]
4. Agree a follow-up plan and safety-net for red flags (rapid growth, voice change, nodes). [1]

Candidate brief

12-minute station. The 14-year-old found a painless lump; the parent has read about thyroid cancer online and asks "is it cancer, and will they need radioactive iodine?" The teen is anxious about a neck scar and school. No prior radiation or family history is offered until you ask. The GP ultrasound report describes a nodule but does not apply a risk tier. [1]

Expected actions

• Address the young person first by name; acknowledge fear about scarring and school. [1]
• Reframe the problem: a nodule is common enough that there is a tested pathway; most are benign, but because children carry higher risk we do not simply watch and wait. [1] [5]
• Explain the next steps in plain terms: a blood test (thyroid function), a specialist high-frequency ultrasound that scores the nodule, and a small needle sample (FNA) only if the nodule meets threshold. [1] [2]
• Avoid committing to surgery or radioiodine now — those decisions depend on the results and a multidisciplinary team. [1] [9]
• Take a radiation and family-cancer history, including any MEN2 or syndromic features. [1] [13]
• Safety-net: return sooner for rapid growth, voice change, or new lumps/nodes. [1]

Examiner prompts

• "Parent: is it cancer?" → Reassure with honest uncertainty; most are benign, but the pathway finds out safely. [1]
• "Teen: will I have a big scar?" → Acknowledge, explain high-volume surgeon and technique, defer detail to the surgical team. [1]
• "Parent: won't they just remove the thyroid?" → Explain that surgery follows diagnosis, not precedes it; extent depends on pathology and the team. [1] [9]

Marking foci

• Young-person-centred communication without over-promising. [1]
• Accurate plain-language explanation of TI-RADS and Bethesda. [1] [2]
• Honest framing of paediatric malignancy risk. [5]
• Appropriate deferral of surgery/radioiodine decisions to the multidisciplinary team. [9]
• Clear safety-netting and follow-up plan. [1]