The most important aspects in obtaining a history of a patient presenting with thyroid nodule include, looking for the presence of associated symptoms, change in nodule size, previous head or neck radiation exposure, childhood irradiation associated with high risk of malignancy, family history, history of neck pain, sudden increase in the size of a neck lump, and progressive voice change or hoarseness. The symptoms associated to thyroid nodule include, dysphagia or anterior neck discomfort, hoarseness, localized pain in the neck, shortness of breath, and prolonged cough.

Obtaining a detailed history is one of the important aspects of determining the best approach towards nodule management. It provides insight into possible cause, precipitating factors and associated comorbid conditions. Complete history may also helps in determining the prognosis. Specific histories about associated symptoms and their duration, onset, and progression have to be obtained. Specific areas of focus when obtaining the history, are outlined below:^[1][2][3]

• The presence of associated symptoms
• A change in nodule size
• Previous head or neck radiation exposure
  • Childhood irradiation associated with high risk of malignancy
• Family history
  • Thyroid diseases
  • Thyroid cancer syndromes
  • Endocrine diseases (e.g. multiple endocrine neoplasia type 2 [MEN2], familial adenomatous polyposis, or Cowden syndrome)
• History of neck pain
• Sudden increase in the size of a neck lump
  • Raise the concern of malignancies and hemorrhagic thyroid cysts
• Progressive voice change or hoarseness
  • May be associated with an invasive thyroid carcinoma

• Dysphagia or anterior neck discomfort
  • May indicate a malignant tumor
  • Rarely seen in benign tumors
  • Choking sensation
  • Inability to lie flat
• Hoarseness
• Localized pain in the neck
• Shortness of breath
• Prolonged cough

These are mainly due to hot nodules producing hormones:^[3][6]

• Palpitation
• Heat intolerance
• Weight loss
• Night sweats