Table 2 Classification of modes of detection for PMC with patient examples and supporting quotes

Physical exam finding

When a thyroid nodule is found during a physical exam (thyroid palpation) of a patient without symptoms concerning for thyroid disorder

Patient went to a local GP for a check-up and the GP felt a lump on his throat

“I went to the local doctors just to sign up, and not that there was anything wrong with us, but, er, and while we were talking the doctor said to me, what’s that lump in your throat?”

Imaging finding

When a thyroid nodule is found during an imaging test requested for reasons unrelated to a thyroid disorder or symptom

CT scan for a pinch nerve in patient’s shoulder

“I was feeling, electrical pulse, pulses going through my shoulder, through my arms to my fingers. And, um, that happened for a few days and then I was worried and I went to see my GP. [He said] “… we’re going to do a scan you might have a pinched nerve or something.””

Diagnostic work up

When a thyroid nodule is found during the work up of clinical symptoms or abnormal laboratory tests that could be suggestive of thyroid disease or known thyroid disease

Patient was not feeling well and blood tests revealed that something may be wrong in her thyroid

“I just went to see the doctor to just see you know there might be something wrong with my chest. So, we did an x-ray and she said look it’s fine. Everything is cleared however we’ll just do a blood test to see if your immunity is maybe a bit low and that’s where she found that my thyroid level was a bit playing up. Which I’d never had any problems before so she just did another test just to make sure and that’s when I sort of, that’s when she sort of found out that there is a bit of a problem.”

Case finding

When a thyroid nodule is found on an ultrasound performed for thyroid cancer screening

Patient lived in Belarus during Chernobyl therefore clinician requested she be screened

“I’m originally from Belarus, and I’m living in Australia for the last 4 years and we have big impact of Chernobyl, what all my doctors think and the, I didn’t have any symptoms anything, I just visit, when I was in Belarus for holidays I just went for the check-up. And they said that because of all my friends had similar problems I thought I just go and check and they said I have a nodule and then I was returned to Australia and they started to keep an eye on it.”

Symptomatic nodule

When a thyroid nodule is found in a symptomatic patient

Felt a lump in his neck so went to the GP to get it checked

“I turned my head I felt strange and I felt in my throat and, er, there was a lump. And, um, which I’d never seen before. And it did come up quite suddenly and it was visible. Um, so, um, I checked with my GP who said it was my thyroid, and he referred me to a specialist.”