The clinician should aim their management strategy at determining the patient’s thyroid function status, and diagnosing thyroid pathology that may require treatment. The approach to the investigation of thyroid disease that we will discuss in this paper has been the work of the Multidisciplinary Thyroid Team at Guy’s and St Thomas’ NHS Foundation Trust. The team includes endocrinologists, radiologists, cytologists, histopathologists, nuclear physicians, clinical oncologists and endocrine and head and neck surgeons. When these guidelines were written, not only the personal experience and the current clinical evidence and controversies was taken into account but also the current patient’s pathway in order to minimize their attendance at outpatients and make the process as efficient and as cost-effective as possible.1