“I found a lump in my neck — it moves when I swallow”

A palpable thyroid nodule with NORMAL thyroid function is the rule, not reassurance — most thyroid cancers are euthyroid — so "the bloods were fine" must never justify leaving a nodule. The work-up is examination (nodule characteristics and cervical nodes), TSH, and thyroid ULTRASOUND with risk-stratification (U-classification/TIRADS) and FNA/specialist referral as indicated. Elicit and weight the risk factors — here previous head/neck irradiation (major) and family history of thyroid cancer — and screen the red flags (rapid growth, hard/fixed nodule, hoarseness/voice change, dysphagia, cervical lymphadenopathy). Under NICE NG12 an unexplained thyroid lump on its own meets the criterion to consider a suspected cancer pathway referral — her risk factors make it clearly right — and stridor needs an immediate same-day opinion (British Thyroid Association 2014). The examinable hidden agenda is cancer-survivor fear: treated for lymphoma as a teenager, she uses the normal TFTs as permission to avoid facing a possible new cancer. Surface and address that fear, balance honesty with reassurance (most nodules benign, thyroid cancer usually very treatable), and complete the ultrasound/referral with a clear safety-net for compressive/voice red flags.