{ "schema_version": 1, "kind": "condition", "id": "thyroid-nodule-referral", "name": "Thyroid Nodule (Evaluation & Referral)", "category": "chronic", "sources": "Egyptian National Drug Formulary - Endocrine System 2024 · ATA Management Guidelines for Adult Patients with Thyroid Nodules 2016", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Endocrine System 2024 · ATA Management Guidelines for Adult Patients with Thyroid Nodules 2016 · Thyroid Nodule - disease-level clinical article (thyroid-nodule-referral-full.txt) · Thyroid Nodule (Evaluation & Referral) - disease-level clinical article (thyroid-nodule-referral-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1781, "generic": "Levothyroxine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.05, "adult_dose": "50-100 mcg once daily in the morning on an empty stomach ONLY if subclinical or overt hypothyroidism co-exists", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (levothyroxine monograph), Hypothyroidism, patients under 50 years age: \"Initially 50 to 100 mcg daily\". The formulary carries no thyroid-nodule indication; this is its hypothyroidism starting dose, the indication under which levothyroxine appears here. The ATA thyroid nodules guideline is not held in this corpus.", "rationale": "Thyroid hormone replacement given only when a thyroid nodule is accompanied by subclinical or overt hypothyroidism, to normalise TSH; not used as suppressive therapy for a euthyroid nodule, which is no longer recommended.", "cautions": [ "Routine TSH suppression therapy for euthyroid nodules is NO LONGER recommended.", "Urgent ultrasound and fine-needle aspiration (FNA) referral is required for red-flag features (rapid growth, dysphagia, hoarseness, hard immobile nodule).", "Strength is 50 mcg = 0.05 mg." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Age-dependent dosing under pediatric endocrinologist supervision only if hypothyroid", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "T4-THYRO 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 9.0, "pack_count": 100, "unit_price": 0.09, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYPOTHYRONOR 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ACDIMA INTERNATIONAL TRADING", "price_egp": 39.0, "pack_count": 100, "unit_price": 0.39, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THYROXINE 50MCG 100 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 46.0, "pack_count": 100, "unit_price": 0.46, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EQUITHERA 50MCG 50 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 26.0, "pack_count": 50, "unit_price": 0.52, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELTROXIN 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASPEN > PHOENIX GROUP", "price_egp": 78.0, "pack_count": 100, "unit_price": 0.78, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUTHYROX 50MCG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK KGAA F.R.GERMANY > MERCK LIMITED - EGYPT", "price_egp": 46.0, "pack_count": 50, "unit_price": 0.92, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUTHYROX 50MCG 100 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK KGAA F.R.GERMANY > MERCK LIMITED - EGYPT", "price_egp": 105.0, "pack_count": 100, "unit_price": 1.05, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "thyroid-nodule-referral" }, { "id": 1782, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Thyroid Nodule - disease-level clinical article (thyroid-nodule-referral-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - The specific physical exam findings that raise concern for malignancy are size >4cm, firmness, fixation, cervical lymphadenopathy, and vocal fold paralysis, and in combination they have a near-100% predictive value.", "RED FLAG - FNA cytology results (Bethesda V suspicious, Bethesda VI malignant) mandate surgical referral regardless of any medical therapy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "thyroid-nodule-referral" } ] }