Categories
Self-organization

How to Diagnose Thyroid Cancer

Articles On Thyroid Cancer

Thyroid Cancer

Thyroid Cancer – How Do I Know If I Have Thyroid Cancer?

  • What Is Thyroid Cancer?
  • Causes & Risks
  • Symptoms
  • Diagnosis
  • Stages & Progression
  • Treatments

Thyroid nodules, or lumps, are very common. Most aren’t cancer.

Your thyroid is the small, butterfly-shaped gland usually located at the bottom front of your neck. If you have a lump on it, chances are you found it yourself, though your doctor may have detectedВ it during a physical exam. If you have discovered a lump on your own, you should get your doctor to check it.

Physical Exam

Your doctor will examine any lumps, or nodules, you have on your neck. They might ask you some questions to find out if you’re at risk. The questions might be about whether you’ve been exposed to too much radiation, or if you have a family history of thyroid cancer or thyroid disease.

Blood Tests

There is no blood test that can detect thyroid cancer. Still, your doctor may want you to get one to help figure out whether your thyroid gland is working right.

Genetic Tests

Based on your family history, your doctor might order genetic testing to find out if you have any genes that make you more likely to get cancer. It can also show genetic changes that could be a sign of certain types of thyroid cancer.

Biopsy

If you have a thyroid lump, you may need to have it tested. A biopsy will tell if it’s cancer or not.

To do a biopsy, your doctor uses a small, thin needle to take a little sample from the lump, and maybe other places around it.

You’ll probably get this “fine-needle biopsy” in your doctor’s office. You won’t need any recovery time afterward.

After theyВ getВ the sample, the doctor will send the sample to a lab for testing.

Ultrasound

An ultrasound helps your doctor learn more about the thyroid nodule(s).В It uses high-frequency sound waves to create an image of your thyroid.

Your doctor will place a small device that looks like a wand in front of your thyroid gland. The image of your thyroid and any nodules, even those you can’t feel, will show up on a computer screen.

An ultrasound may show your doctor if a lump is filled with fluid or if it’s solid. A solid one is more likely to have cancerous cells, but you’ll still need more tests to find out. The ultrasound will also show the size and number of nodules on your thyroid.

Continued

Radioiodine Scan

This test uses radioactive iodine which will be taken up by thyroid cells. A scan measures radiation in the thyroid or other parts of the body.

CT Scan

Computed tomography, commonly called a CT scan or CAT scan, uses special X-rays to give your doctor a look inside of your body. It can show the size and location of thyroid cancer and whether it has spread to other parts of your body.

PET Scan

Your doctor might recommend a positron emission tomography, or PET scan. This test uses small amounts of radioactive material, called radiotracers, a special camera, and a computer to look at your organs and tissue.

A PET scan looks at changes on the cellular level. It may be able to detect the cancer in a very early state and check for cancer spread.

Your doctor will give you the results of your tests.

Act Fast

Remember that the odds are the lump on your neck probably isn’t thyroid cancer, but you’re doing the right thing to get it checked out. And if it is, the sooner you find out and start treatment, the better.

Sources

National Cancer Institute: “A Snapshot of Thyroid Cancer.”

Endocrine Practice, “The Increasing Incidence of Thyroid Cancer.”

American Thyroid Association: “Thyroid Cancer.”

Light of Life Foundation: “Thyroid Cancer Q&A.”

Mayo Clinic: “Thyroid cancer.”

Radiological Society of North America, Inc.: “Ultrasound-Thyroid.”

East Jefferson Imaging Center: “Q&A: About Your CT Scan.”

PET Professional Resources and Outreach Source: “PET Scans: Get the Facts.”

Tests and Exams to Diagnose Thyroid Cancer

In order to accurately diagnose and treat thyroid cancer, your doctor thoroughly reviews your complete medical history, which may include information about family members who may have had a thyroid cancer, benign tumor, or multiple endocrine neoplasia. The doctor performs a physical examination and orders tests such as blood work.

During the physical exam, the doctor palpates (feels) your neck, which may require you to swallow and flex and bend your neck. He or she will pay particular attention to the thyroid gland and surrounding tissues, such as the lymph nodes. The number, size, shape, and firmness of the nodule(s) are carefully examined. The doctor correlates the physical findings with your medical history and reported symptoms, such as pain or hoarseness.

Fact: The American Thyroid Association reports that while thyroid lumps (nodules) are common, fewer than 1 in 10 is cancer. 1

Family History as Part of Thyroid Cancer Diagnosis
If you have a family history of medullary thyroid cancer, the doctor will test your blood calcitonin and calcium levels. Calcitonin is a hormone important to calcium and phosphorus metabolism and bone growth. An elevated calcitonin level can indicate cancer.

Laboratory Tests to Diagnose Thyroid Cancer
Blood is drawn to test your thyroid gland function. Results from a thyroid-stimulating hormone (TSH) test either confirms or rules out hypothyroidism (too low) or hyperthyroidism (too high) levels. If your thyroid gland does not function normally, a T3 or Free T3 (triiodothyronine) and T4 (thyroxine) test is run to determine your thyroid hormone activity levels. It is important to remember that thyroid function tests are not indicators of thyroid cancer and most people with thyroid cancer have normal thyroid function.

How to Diagnose Thyroid Cancer

Thyroid Scan
A thyroid scan, or nuclear medicine scan, tests the gland’s function. After a radioactive tracer is injected, a special camera captures images of the thyroid gland and measures the amount of dye the gland (nodules) absorbs.

Normal and abnormal test results are reported as functioning (normal), cold (underactive), or hot (overactive). Suspicious cold nodules can be further evaluated by a procedure called fine needle aspiration (needle biopsy). Hot nodules do not generally require biopsy.

Ultrasound Guided Biopsy with Fine Needle Aspiration (FNA)
Fine needle aspiration (FNA) is one way of diagnosing thyroid cancer. A local anesthetic may be injected into/around the neck area. Using ultrasound to guide needle placement, your doctor takes several samples of the nodule or tumor. The samples are sent to pathology for microscopic evaluation.

Some fine needle aspiration biopsy results are indeterminate. This means it is not exactly known if the nodule or tumor is benign (noncancerous) or malignant (cancer). To help patients avoid unnecessary thyroid surgery, new molecular testing (gene expression classification) may be performed to help confirm an accurate diagnosis.

Undergoing FNA can be a distressing time for patients. Questions you may want to ask your doctor can help put your mind at ease.

  • Where will my FNA be performed?
  • How long does the test take?
  • Is FNA painful?
  • How many of these procedures do you performed each month?
  • What are the risks? Bleeding, infection?
  • Should I stop taking any over-the-counter or prescription medications before the test?
  • How soon until I have the results of the test?
  • If I have thyroid cancer, what’s next?

How to Diagnose Thyroid Cancer Imaging Studies
Results from imaging studies may assist your doctor in confirming your thyroid cancer diagnosis. Different types of imaging studies include x-ray, computed tomography (CT scan), magnetic resonance imaging (MRI), and positron emission tomography (PET scan).

Laryngoscopy
Depending on your tumor’s characteristics, and the close proximity of your thyroid gland to your voice box (larynx), your doctor may recommend laryngoscopy. A laryngoscope is a lighted and flexible tube with magnification used to examine your larynx.

Drawing Conclusions
After your doctor has evaluated each piece of information about your health, including test results, he makes his diagnosis and outlines a treatment plan for your thyroid cancer.

Bridget Brady, MD, FACS is the first fellowship-trained endocrine surgeon in Austin, Texas. She has a passion for and expertise in disease of the thyroid, parathyroid, and adrenal glands. Dr. Brady has performed thousands of thyroidectomies and parathryoidectomies with a focus on minimally invasive techniques to optimize patients’ medical and cosmetic outcomes.

The first step in developing a personalized thyroid cancer treatment plan is getting an accurate diagnosis. Various tests and procedures designed for diagnosing thyroid cancer are used to evaluate and stage the disease. For example, an ultrasound may help the oncologist inspect the thyroid for nodules, and a biopsy may be taken to retrieve and test tissue samples. An X-ray of the chest may reveal whether cancer has spread to the lungs.

Common tests used for diagnosing thyroid cancer include:

Biopsy

A sample of throat tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing head and neck cancers are:

Fine needle aspiration (FNA): With this test, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with laryngeal cancer.

Incisional biopsy: If further testing is needed after a fine needle aspiration, a small piece of tissue may be cut from an abnormal-looking area. Because the larynx is deep inside the neck, removing samples involves a complex procedure. Therefore, biopsies of this region are usually done in an operating room, with general anesthesia administered to prevent any pain.

Imaging tests

X-ray: An X-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage.

CT scan: Computed tomography (CT) scan (also known as a computed axial tomography scan, or CAT scan) is one of the most commonly used tools for the screening, diagnosis and treatment of cancer. This test for thyroid cancer is usually used to see if the disease has spread to other areas of the body, but may also sometimes be used to guide the biopsy needle.

MRI: Magnetic resonance imaging (MRI) is an imaging tool designed to create detailed, cross-sectional pictures of the inside of the body. Using radiofrequency waves, powerful magnets and a computer, MRI systems may distinguish between normal and diseased tissue. MRI may be used to look at the brain and spinal cord, locations where thyroid cancer may spread (metastasize).

Nuclear medicine scan: The most common test used for patients with thyroid cancer is a radioiodine scan, which involves swallowing or injecting a small amount of radioactive iodine, or I-131. This test is often used in patients with differentiated forms of the disease (papillary, follicular, Hürthle cell). It may be used to identify abnormal areas of the thyroid gland, or to determine if the cancer has spread to other areas of the body.

PET scan: Positron emission tomography (PET) is a nuclear imaging technique that creates detailed, computerized pictures of organs and tissues inside the body. PET scans are very sensitive, but they do not show much detail, so they will often be performed in combination with a CT scan (called PET/CT). In many cases, we use the GE Discovery™ PET/CT 600 scanner, a state-of-the-art four-dimensional CT scanner produces detailed cross-sectional X-ray images of structures in the body. It also enables our radiologists to plan treatment in accordance with patients’ breathing patterns.

Ultrasound: Also known as sonography, this non-invasive procedure can help doctors determine the size of nodules on the thyroid and see how many are present. It may also help determine whether the suspected nodule is solid, or filled with fluid. Sometimes, ultrasound is also used to guide the biopsy needle when nodules are small.

Lab tests

Various laboratory tests are used to diagnose thyroid cancer. They include:

Advanced genomic testing: Genomic testing examines a tumor on a genetic level to look for the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell’s genome, we can better understand what caused the tumor and tailor treatment based on these findings.

Nutrition panel: With this test, we evaluate patients for deficiency of nutrients, such as vitamin D and iron. The test helps us identify the nutrients patients need replaced or boosted to support their quality of life.

Other lab tests that may be used include a thyroid function test, as well as level tests of the thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4). Levels of the protein thyroglobulin are also typically tested before and after surgery.

Laryngoscopy

A laryngoscopy is often used to examine the back of the throat. The two types of laryngoscopy are indirect laryngoscopy and direct laryngoscopy. Because the thyroid gland is so close to the vocal cords, thyroid tumors may sometimes affect them. For this reason, your doctor may want to examine the cords first with special tools, such as a laryngoscope, if you are scheduled for surgery.

Articles On Thyroid Cancer

Thyroid Cancer

Thyroid Cancer – What Is Thyroid Cancer?

  • What Is Thyroid Cancer?
  • Causes & Risks
  • Symptoms
  • Diagnosis
  • Stages & Progression
  • Treatments

Your thyroid is shaped like a small butterfly, and is usually found inside the lower front of your neck. It’s a gland that controls your metabolism. It also releases hormones that direct many functions in your body, including how you use energy, how you produce heat, and how you consume oxygen.

Thyroid cancer develops when cells change or mutate.В The abnormal cells begin multiplying in your thyroid and, once there are enough of them, they form a tumor.

If it’s caught early, thyroid cancer is one of the most treatable forms of cancer.

Types of Thyroid Cancer

Researchers have identified four main types:

Papillary thyroid cancer. If you have thyroid cancer, you probably have this type. It’s found in up to 80% of all thyroid cancer cases. It tends to grow slowly, but often spreads to the nymph nodes in your neck. Even so, you have a good chance for a full recovery.

Follicular thyroid cancer makes up between 10% and 15% of all thyroid cancers in the United States. It can spread into your lymph nodes and is also more likely to spread into your blood vessels.

Medullary cancer is found in about 4% of all thyroid cancer cases. It’s more likely to be found at an early stage because it produces a hormone called calcitonin, which doctors keep an eye out for in blood test results.

Anaplastic thyroid cancer can be the most severe type, because it’s aggressive in spreading to other parts of the body.В It’s rare, and it is the hardest to treat.В

​​​​​​What Are the Symptoms?

If you have thyroid cancer, you probably didn’t notice any signs of it in the early stages. That’s because there are very few symptoms in the beginning.

But as it grows, you could notice any of the following problems:

  • Neck, throat pain
  • Lump in your neck
  • Difficulty swallowing
  • Vocal changes, hoarseness
  • Cough

What Causes It?

There is no clear reason why most people get thyroid cancer. There are certain things, though, that can raise your odds of getting it.

Continued

Inherited genetic syndromes. Some conditions, including cancer, come from the DNA you get from your parents. In 2 out of 10 cases of medullary thyroid cancer, for example, the cancer is a result of an abnormal gene you’ve inherited.

Iodine deficiency. If you don’t get much of this chemical element in your diet, you could be at more risk for certain types of thyroid cancer. This is rare in the United States because iodine is added to salt and other foods.

Radiation exposure. If your head or neck wasВ exposed to radiation treatment as a child.

Who Gets It?

Thyroid cancer is more common in women than men. Women tend to get thyroid cancer in their 40s and 50s, while men who get it are usually in their 60s or 70s.

Follicular thyroid cancer happens more often in whites than blacks and in more women thanВ men.

You can still get thyroid cancer if you’re younger. Papillary thyroid cancer, for example, happens most often in people between ages 30 and 50.

Is It Treatable?

Thyroid cancer is usually very treatable, even if you have a more advanced stage of it. That’s because there are effective treatments that give you a great chance for a full recovery. And surgery, when it’s needed, can sometimes cure it.

Sources

American Thyroid Association: “Thyroid Cancer.”

MD Anderson Cancer Center: “Thyroid Cancer Facts.”

Davies, L., Morris, L.G., Haymart, M., Chen, A.Y, Goldenberg, D., Morris, J., Ogilvie, J.B., Terris, D.J., Netterville, J., Wong, R.J., Randolph, G., Endocrine Practice, published online June 2015.

Home Health Network: “Thyroid.”

Mayo Clinic: “Thyroid cancer.”

The American Association of Endocrine Surgeons: “Thyroid cancer: Papillary Thyroid Cancer (PTC).”

American Cancer Society: “Thyroid cancer risk factors.”

Columbia University Department of Surgery: “What Causes Thyroid Cancer?”

National Cancer Institute: “Thyroid Cancer-Patient Version.”

How to Diagnose Thyroid Cancer

Endocrinology Chief James Fagin and other MSK doctors have played an important role in improving the way doctors classify thyroid cancers into different types, and in linking this information with how patients will respond to treatment.

Thyroid tumors are found and diagnosed in a number of ways.

Some people notice thyroid cancer symptoms, such as a swelling or a small nodule (called a thyroid nodule) in the front of the neck, and ask their doctor for an examination. But many people have no symptoms. If you’re worried about having thyroid cancer, talk to your doctor about an evaluation.

Steps to a Thyroid Cancer Diagnosis

During your first appointment at MSK, we’ll do a physical examination. We’ll check for any unusual growths or swelling in your:

  • thyroid gland
  • throat
  • vocal cords
  • lymph nodes

We’ll also review any tests you’ve already had done.

An ultrasound (using sound waves) of your neck helps us figure out whether we should look at a thyroid nodule more closely in the form of a biopsy. We may also recommend that you get imaging tests — such as a CT, MRI, or PET scan — to get a better look at a thyroid nodule.

For people in New Jersey, we offer a specialized thyroid nodule assessment program at our Basking Ridge and Monmouth locations.

Thyroid Biopsy

To do a biopsy, we remove a small sample of tissue from the area to examine under a microscope. This test helps us figure out if a thyroid nodule is benign (noncancerous) or malignant (cancerous).

We use two types of biopsies to diagnose thyroid cancer.

  • Fine needle aspiration can be done in a doctor’s office or by a radiologist. Ultrasound helps us guide a very thin needle into the thyroid nodule to remove a small number of cells.
  • Core biopsy is done for thyroid cancer that has spread (metastasized) outside the thyroid gland or is more advanced. This approach involves using a larger needle.

One of our expert pathologists analyzes the retrieved cells under a microscope to see if cancer cells are there, and what type of cancer cells they are.

What Is Molecular Testing for Thyroid Cancer?

When needed, we use molecular testing of tissue from a thyroid nodule to see if cancer cells are there.

  • DNA approach: This type of molecular test looks for a few specific DNA mutations in the tissue that have been linked to thyroid cancer.
  • Gene classifier: This type of molecular test doesn’t look at specific mutations. Instead, it concentrates more on how various genes linked to thyroid cancer are expressed.

Blood Tests

Blood tests can help us figure out if the thyroid gland is working normally.

  • If your TSH level is low, a thyroid stimulating hormone (TSH) test for follicular thyroid cancer can indicate if there is a thyroid nodule making high levels of thyroid hormone.
  • The level of the hormone calcitonin in the blood is important to test for evaluating medullary thyroid carcinoma (MTC). Our Hereditary Cancer & Genetics program offers information about how to get tested for MTC, which we recommend to children and siblings of people with this type of thyroid cancer.

Risk Levels for Thyroid Cancer

We use information from the diagnosis of thyroid cancer to determine the cancer’s risk level. The risk level reflects in part how likely it is that the cancer will spread beyond the thyroid gland.

What Is Low-Risk Thyroid Cancer?

Thyroid cancer is called low-risk if it is small and still within the thyroid gland (meaning it hasn’t spread beyond the thyroid). Most patients are between age of 20 and 45.

What Is High-Risk Thyroid Cancer?

Thyroid cancer is called high-risk if the disease has spread beyond the thyroid gland or if it grows quickly. Most patients are over age 45.

Our doctors offer treatment options to you based on whether your disease is low-risk or high-risk.

The first step in developing a personalized thyroid cancer treatment plan is getting an accurate diagnosis. Various tests and procedures designed for diagnosing thyroid cancer are used to evaluate and stage the disease. For example, an ultrasound may help the oncologist inspect the thyroid for nodules, and a biopsy may be taken to retrieve and test tissue samples. An X-ray of the chest may reveal whether cancer has spread to the lungs.

Common tests used for diagnosing thyroid cancer include:

Biopsy

A sample of throat tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing head and neck cancers are:

Fine needle aspiration (FNA): With this test, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with laryngeal cancer.

Incisional biopsy: If further testing is needed after a fine needle aspiration, a small piece of tissue may be cut from an abnormal-looking area. Because the larynx is deep inside the neck, removing samples involves a complex procedure. Therefore, biopsies of this region are usually done in an operating room, with general anesthesia administered to prevent any pain.

Imaging tests

X-ray: An X-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage.

CT scan: Computed tomography (CT) scan (also known as a computed axial tomography scan, or CAT scan) is one of the most commonly used tools for the screening, diagnosis and treatment of cancer. This test for thyroid cancer is usually used to see if the disease has spread to other areas of the body, but may also sometimes be used to guide the biopsy needle.

MRI: Magnetic resonance imaging (MRI) is an imaging tool designed to create detailed, cross-sectional pictures of the inside of the body. Using radiofrequency waves, powerful magnets and a computer, MRI systems may distinguish between normal and diseased tissue. MRI may be used to look at the brain and spinal cord, locations where thyroid cancer may spread (metastasize).

Nuclear medicine scan: The most common test used for patients with thyroid cancer is a radioiodine scan, which involves swallowing or injecting a small amount of radioactive iodine, or I-131. This test is often used in patients with differentiated forms of the disease (papillary, follicular, Hürthle cell). It may be used to identify abnormal areas of the thyroid gland, or to determine if the cancer has spread to other areas of the body.

PET scan: Positron emission tomography (PET) is a nuclear imaging technique that creates detailed, computerized pictures of organs and tissues inside the body. PET scans are very sensitive, but they do not show much detail, so they will often be performed in combination with a CT scan (called PET/CT). In many cases, we use the GE Discovery™ PET/CT 600 scanner, a state-of-the-art four-dimensional CT scanner produces detailed cross-sectional X-ray images of structures in the body. It also enables our radiologists to plan treatment in accordance with patients’ breathing patterns.

Ultrasound: Also known as sonography, this non-invasive procedure can help doctors determine the size of nodules on the thyroid and see how many are present. It may also help determine whether the suspected nodule is solid, or filled with fluid. Sometimes, ultrasound is also used to guide the biopsy needle when nodules are small.

Lab tests

Various laboratory tests are used to diagnose thyroid cancer. They include:

Advanced genomic testing: Genomic testing examines a tumor on a genetic level to look for the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell’s genome, we can better understand what caused the tumor and tailor treatment based on these findings.

Nutrition panel: With this test, we evaluate patients for deficiency of nutrients, such as vitamin D and iron. The test helps us identify the nutrients patients need replaced or boosted to support their quality of life.

Other lab tests that may be used include a thyroid function test, as well as level tests of the thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4). Levels of the protein thyroglobulin are also typically tested before and after surgery.

Laryngoscopy

A laryngoscopy is often used to examine the back of the throat. The two types of laryngoscopy are indirect laryngoscopy and direct laryngoscopy. Because the thyroid gland is so close to the vocal cords, thyroid tumors may sometimes affect them. For this reason, your doctor may want to examine the cords first with special tools, such as a laryngoscope, if you are scheduled for surgery.

Fine Needle Aspiration Biopsy Is the Most Common Test

There are a number of tests your doctor may use to diagnose papillary thyroid cancer (also known as papillary thyroid carcinoma). This article explains the most common diagnostic tests for thyroid cancer—fine needle aspiration biopsy, ultrasound, and blood tests.

Fine Needle Aspiration Biopsy
As with all forms of cancer, thyroid cancer is diagnosed from the results of a biopsy. To determine if a thyroid nodule is cancerous, doctors use a fine needle aspiration biopsy (FNA). This is usually the first test doctors will use if they suspect thyroid cancer—and in some cases, it may be the only test used.

In an FNA biopsy, a doctor inserts a thin, hollow needle into the thyroid tissues and removes a sample of cells. Your doctor may repeat this a few times to retrieve samples from different parts of the swollen nodule. The extracted cells are then examined under a microscope to determine if they are benign or cancerous. This is generally done under ultrasound guidance for preciseness and to ensure that enough cells are extracted for the pathologists to make a judgment.

To get more details about FNA, read our article about fine needle aspiration biopsy.

Imaging Tests
Your doctor may order imaging tests to better view the thyroid. Arguably the most common imaging test for thyroid cancer is an ultrasound. An ultrasound uses sound waves to create an image of the thyroid. A small, hand-held instrument is placed on the skin over the thyroid and transmits the sound waves and produces an image.

An ultrasound shows whether the thyroid nodule is fluid-filled or solid (solid nodules are more likely to be cancerous). Plus, it highlights all the thyroid nodules and nearby lymph nodes. Another benefit of ultrasound is that it helps doctors accurately guide the needle when they perform a fine needle aspiration biopsy.

This diagnostic test is safe, quick, and painless. But ultrasound alone cannot definitively show whether a thyroid nodule is cancerous. However, ultrasound can show certain features that suggest a nodule is likely to be cancerous. In these cases, a FNA biopsy is usually performed to confirm the findings.

To learn more about this diagnostic test, read our article about thyroid nodule ultrasound.

Your doctor may also order a CT scan after your thyroid cancer is confirmed if there is suggestion that the cancer may be extending outside the thyroid in certain ways. CT scans are not frequently ordered at the time of thyroid cancer diagnosis unless there are indications, such as the need to see the relationship between the cancer and the esophagus (feeding tube) and the trachea (air pipe).

Blood Tests
Though blood tests alone can’t diagnose papillary thyroid cancer, they can determine if you have healthy levels of thyroid-stimulating hormone (TSH). This information will help your doctor understand how well your thyroid gland is functioning overall. If it is found to be over-functioning (hyperthyroid), then this has implications for further work-up with a thyroid nuclear scan and for medical treatment.

Before the routine use of ultrasound in evaluating thyroid nodules, patients would get nuclear scans. These scans would characterize thyroid nodules as cold or hot.

Hot nodules create excess TSH without signals from the pituitary gland, but they are rarely cancerous.

Cold nodules, on the other hand, do not produce hormones, but they are more likely to be cancerous. However, since ultrasound has been so successful in evaluating the thyroid nodules, a thyroid scan is rarely necessary in the management of thyroid nodules anymore.

Thyroid nodules with a hyperthyroid picture on TSH are rarely cancerous and most of the time, do not need a biopsy.

If you have a suspicious lump near your throat, or believe you have many of the risk factors associated with papillary thyroid cancer, talk to your doctor. He or she will examine your thyroid and will order a thyroid ultrasound to see if you have any nodules requiring a fine needle aspiration biopsy. Remember, the sooner you recognize the symptoms and seek medical care, the more likely you are to respond well to treatment.

How Is Thyroid Cancer Diagnosed?

Most people who are eventually diagnosed with thyroid cancer first come to their doctor after noticing a lump in their neck, so the diagnostic process usually starts with an evaluation of this nodule. The first step is a medical history and physical exam from a medical professional. Blood and imaging tests for thyroid cancer may follow. A thyroid biopsy is used to confirm the diagnosis of thyroid cancer.

What Happens During the History and Physical Exam for Thyroid Cancer Diagnosis?

During the history, a medical professional will ask questions about risk factors like radiation exposure and thyroid cancer in other family members.

During the physical exam, a medical professional will check the thyroid nodule size, how firm it feels, and for swelling of nearby lymph nodes.

A medical professional will also ask and look for signs and symptoms of too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone activity (including changes in weight, changes in energy levels, and feeling too hot or too cold). These changes usually suggest that the thyroid nodule is NOT a cancer.

What Blood Tests Are Used For Thyroid Diagnosis?

Thyroid hormone levels can be measured from blood samples and used to help figure out if thyroid nodules are cancerous or not.

A hormone called TSH (Thyroid Stimulating Hormone) is checked to get a sense of overall thyroid activity. TSH is not actually made in the thyroid, but it helps regulate the production of other thyroid hormones. Most patients with thyroid cancer will have normal TSH levels.

Blood samples will also be checked for T3 & T4 (the metabolism-controlling hormones) and calcitonin (the calcium-controlling hormone). Most thyroid cancers will have normal T3 and T4 levels.

High calcitonin levels are often seen in medullary thyroid cancer. A blood protein called CEA may also be elevated in those with this form of cancer. People with medullary thyroid cancer can also have a CEA blood test to check for genetic mutations linked to other conditions, like MEN-2.

What Imaging Tests Are Used For Thyroid Diagnosis?

A Thyroid Ultrasound (USG) of the neck can be used to gain information about a thyroid nodule without exposing it to any radiation.

USG results that suggest a nodule is cancerous include:

  • a dark appearance (called a hypoechoic nodule)
  • small calcium deposits (microcalcifications)
  • more blood vessels than normal (hypervascularity)
  • irregular borders

To confirm the diagnosis of a thyroid cancer, a thyroid biopsy is used.

What Is A Thyroid Biopsy?

A thyroid biopsy involves collecting a small sample of cells so they can be looked at under a microscope for signs of cancers. A small, thin needle placed within a thyroid nodule can draw up the needed cells.

This is called a Fine Needle Aspiration, and can usually be done in a typical exam room with local anesthesia (medicine that numbs the injection area but doesn’t put you to sleep). An ultrasound may be used to help guide the needle into the nodule.

The FNA may give one of four results:

Non-diagnostic:

This means that not enough cells were removed to make a diagnosis. Even in the best of hands, this happens 5 to 10% of the time. Typically the FNA will be repeated.

Benign Thyroid Nodule:

This means that there is a 97% chance that the thyroid nodule is not cancer. In most cases, patients with a benign biopsy are watched with an USG and physical exam 6 months later, and then at regularly scheduled times.

Malignant Thyroid Nodule:

This means that there is a 97% chance that the thyroid nodule is cancer (usually a papillary thyroid cancer). Sometimes the results say that the thyroid nodule is “suspicious for thyroid cancer” which means that there is an 80 to 90% chance of cancer.

Indeterminate:

This means that the cells do not look normal, but they are not clearly cancer cells. There is a 15 to 20% chance of having thyroid cancer with an indeterminate biopsy.

What If The Thyroid Biopsy Does Not Give A Clear Diagnosis?

If there is still uncertainty after the biopsy, the next step may be surgery to get better access to the thyroid and remove a larger section.

Surgery is often necessary to diagnose follicular thyroid cancer and Hurthle cell carcinoma.

Are There Any Tests Done After The Diagnosis Is Made?

After a diagnosis of thyroid cancer has been made, a CT scan may be used to see if the disease has spread to other parts of the body (particularly in cases of anaplastic thyroid cancer).

If a diagnosis of thyroid lymphoma is made, a total body PET scan may be done to look for lymphoma elsewhere in the body in order to stage the patient.

What Are The Stages Of Thyroid Cancer?

Thyroid cancer can be grouped into different stages, based on their size, their spread, and the involvement of nearby lymph nodes. These stages can help determine treatment options and likely outcomes.

Many cancers are staged using the TNM system. “T” stands for the size of the tumor, “N” describes lymph node spread, and “M” describes any spread to other organs (called metastases.)

Each of the TNM variables can be further broken down like this:

T: Tumor size (in cm)

  • T1: 4 cm
  • T4: tumor grows outside of the thyroid
    • T4a: grows into nearby structures
    • T4b: grows in spine or nearby large blood vessels

N: Lymph Nodes

  • NX: regional lymph nodes can’t be assessed
  • N0: no involved regional lymph nodes
  • N1: involved regional lymph nodes
    • N1a: involved central neck lymph nodes
    • N1b: involved lateral neck or mediastinal (chest) lymph nodes

M: Metastases

  • M0: no distant metastases
  • M1: distant metastes (usually to the lungs, the liver, or bones)

Based on these three categories, the cancer is assigned a Stage of 1, 2, 3 or 4. Stage 1 is the least advanced form of cancer, and Stage 4 is the most advanced.

All anaplastic thyroid cancers are considered Stage 4.

Next Steps

If you are dealing with a thyroid issue, our team at the Columbia Thyroid Center is here to help. Call (212) 305-0444 or request an appointment online.

To keep learning about Thyroid Cancer: Overview | Types | Causes | Symptoms | Diagnosis | Treatment | Prognosis/Outcomes

What is thyroid cancer?

Thyroid cancer develops in the thyroid, a small butterfly-shaped gland at the base of your neck. This gland produces hormones that regulate your metabolism (how your body uses energy). Thyroid hormones also help control your body temperature, blood pressure and heart rate. Thyroid cancer, a type of endocrine cancer, is generally highly treatable with an excellent cure rate.

What is the thyroid gland?

Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.

The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone (TSH). As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.

Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.

Where is your thyroid gland?

The thumb-sized thyroid gland sits at the base of your neck, in front of your windpipe and below your Adam’s apple. The thyroid gland resembles a butterfly. A bridge of tissue connects the right and left lobes, or sides.

How common is thyroid cancer?

Close to 53,000 Americans receive a diagnosis of thyroid cancer every year. Treatments for most thyroid cancers are very successful. Still, about 2,000 people die from the disease every year.

Who might have thyroid cancer?

Women are three times more likely than men to get thyroid cancer. The disease is commonly diagnosed in women in their 40s and 50s, and men in their 60s and 70s. Even children can develop the disease. Risk factors include:

  • Enlarged thyroid (goiter).
  • Family history of thyroid disease or thyroid cancer.
  • Thyroiditis (inflammation of the thyroid gland).
  • Gene mutations (changes) that cause endocrine diseases, such as multiple endocrine neoplasia type 2A (MEN2A) or type 2B (MEN2B) syndrome.
  • Low iodine intake.
  • Obesity (high body mass index).
  • Radiation therapy for head and neck cancer, especially during childhood.
  • Exposure to radioactive fallout from nuclear weapons or a power plant accident.

What are the types of thyroid cancer?

Thyroid cancer is classified based on the type of cells from which the cancer grows. Thyroid cancer types include:

  • Papillary: Up to 80% of all thyroid cancers are papillary. This cancer type grows slowly. Although papillary thyroid cancer often spreads to lymph nodes in the neck, the disease responds very well to treatment. Papillary thyroid cancer is highly curable and rarely fatal.
  • Follicular: Follicular thyroid cancer accounts for up to 15% of thyroid cancer diagnoses. This cancer is more likely to spread to bones and organs, like the lungs. Metastatic cancer (cancer that spreads) can be more challenging to treat.
  • Medullary: About 2% of thyroid cancers are medullary. A quarter of people with medullary thyroid cancer have a family history of the disease. A faulty gene (genetic mutation) may be to blame.
  • Anaplastic: This aggressive thyroid cancer is the hardest type to treat. It can grow quickly and often spreads into surrounding tissue and other parts of the body. This rare cancer type accounts for about 2% of thyroid cancer diagnoses.

What causes thyroid cancer?

Experts aren’t sure why some cells become cancerous (malignant) and attack the thyroid. Certain factors, such as radiation exposure, a diet low in iodine and faulty genes can increase risk.

What are the symptoms of thyroid cancer?

You or your healthcare provider might feel a lump or growth in your neck called a thyroid nodule. Don’t panic if you have a thyroid nodule. Most nodules are benign (not cancer). Only about three out of 20 thyroid nodules turn out to be cancerous (malignant).

Other signs of thyroid cancer include:

  • Difficulty breathing or swallowing.
  • Loss of voice (hoarseness).
  • Swollen lymph nodes in the neck.

Last reviewed by a Cleveland Clinic medical professional on 08/13/2020.

References

  • American Cancer Society. Thyroid Cancer. Accessed 8/13/2020.
  • American Thyroid Association. Thyroid Cancer (Papillary and Follicular). Accessed 8/13/2020.
  • Merck Manual. Thyroid Cancer. Accessed 8/13/2020.
  • National Cancer Institute. Thyroid Cancer. Accessed 8/13/2020.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

How to Diagnose Thyroid Cancer

Hearing the words “thyroid cancer” is a frightening shock for many people. So, your first step is to take a deep breath, and give yourself the time and space to process this information. In most cases, you have plenty of time to make decisions that are right for you. Don’t let your doctors rush you into treatment decisions before you have fully researched and understood your situation.

Get More Information

In today’s healthcare environment, you need to be CEO and project manager of your health. And that means doing some research and becoming informed, so you can make good choices. A great starting point is connecting with the Thyroid Cancer Survivors’ Association (ThyCa) , a non-profit group dedicated to helping thyroid cancer patients and their families. Read, sign up for their newsletters, and join their patient support community to help you get up to speed on the specifics of your particular type of thyroid cancer.

Make Sure Your Doctors Are Sure

Thyroid cancer is usually diagnosed after a fine needle aspiration (FNA) biopsy of your thyroid. Some biopsy results are definitive: You either have thyroid cancer or you don’t. But if your biopsy is classified as “indeterminate” or “inconclusive,” thyroid cancer can’t be ruled out.

Many doctors still recommend that you have surgery—known as thyroidectomy—to remove the gland. Don’t get rushed into this decision. There are genetic tests—one popular one is the Afirma Thyroid Analysis from Veracyte —which can dramatically reduce the chance of indeterminate results. You don’t want to have thyroid surgery to remove your gland (and lifelong hypothyroidism as a result) only to learn afterward that your thyroid nodule was, in fact, not cancerous.

Make Sure You Definitely Need Surgery

In most cases, if you have a diagnosis of thyroid cancer, doctors will recommend surgery. If you have a very small papillary thyroid cancer, however, some cutting-edge practitioners are now advising against surgery.

Instead, they recommend “active surveillance” (also known as “watchful waiting), where your nodule is monitored periodically for changes, and action is taken if needed. Research shows that both approaches have similar outcomes, but active surveillance allows you to avoid surgery, keep your thyroid gland, and avoid lifelong hypothyroidism. Ask about this option and get a second opinion when needed.

UP NEXT: HOW THYROID CANCER SURVIVORS CAN THRIVE

Choose an Experienced Surgeon

If you do need to have thyroid surgery, it’s crucial that you find an experienced surgeon. Research shows that risks of complications are dramatically reduced, and recuperation time is significantly shorter when thyroid surgery is performed by a specialized thyroid surgeon who does at least 50 thyroid surgeries per year.

While your local general surgeon (or ear, nose, and throat expert) may be able to do a thyroid surgery, you’d be smart to choose a surgeon who has a great deal of experience performing thyroid surgeries. Here are some resources to help you find an experienced thyroid surgeon:

Be Empowered

Because most cases of thyroid cancer are highly treatable and survivable, and don’t usually require chemotherapy or radiation like other cancers, thyroid cancer has been deemed “the good cancer”—much to the frustration of those actually going through it!

Don’t be surprised if doctors—not to mention family and friends—downplay your concerns using this “good cancer” line. Even with a good prognosis, any cancer is scary, and treatments like surgery, radioactive iodine (RAI), regular monitoring for recurrence, and lifelong thyroid hormone replacement are no walk in the park.

You may want to be empowered and proactive with others, and say something like, “I know that the prognosis for my thyroid cancer is good, but I need you to take my fears, concerns, and questions seriously.”

Life After Thyroid Cancer

When you have had a thyroidectomy to remove a cancerous thyroid gland, you will become hypothyroid, and require lifelong thyroid hormone replacement medication to stay well.

An important aspect of your quality of life post-surgery will be understanding the medications so you have optimal hypothyroidism treatment and enjoy the best possible health. A great starting point: Learn more about thriving with hypothyroidism here at ThyroidRefresh ® and join our THYROID30 ® community! You don’t have to endure this alone.

It’s a good idea to see your GP if you have possible symptoms of thyroid cancer.

Your GP will examine your neck and ask about any other symptoms you may be experiencing, such as unexplained hoarseness.

If they think you might have a thyroid problem, they may organise some tests or refer you to a hospital specialist.

The tests you may have are described below.

Blood test

A blood test called a thyroid function test is used to check the levels of thyroid hormones in your blood.

Abnormal levels could mean that you have an overactive thyroid or an underactive thyroid, rather than cancer.

Further tests, such as an ultrasound scan, will be needed if the test shows that your thyroid hormone levels are normal.

Ultrasound scan

An ultrasound scan uses sound waves to create an image of the inside of your body.

An ultrasound scan of your neck can check for a lump in your thyroid that could be caused by cancer.

If a potentially cancerous lump is found, a biopsy will be done to confirm the diagnosis.

Biopsy

The only way to confirm if a lump on the thyroid is cancer is to take a biopsy. This is where a small sample of cells are removed and studied under a microscope.

A biopsy of the thyroid is usually done by inserting a thin needle into the lump. An ultrasound scan may be done at the same time to guide the needle into the right place.

This is usually done as an outpatient procedure, which means you will not have to spend the night in hospital.

Further tests

If a biopsy finds that you have thyroid cancer, further tests may be needed to check whether the cancer had spread to another part of your body.

The main tests used for this are:

  • a CT scan – a type of scan that uses a series of X-rays and a computer to create detailed images of the inside of the body
  • a MRI scan – a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body

Stages of thyroid cancer

If you are diagnosed with thyroid cancer, your doctor may give the cancer a stage.

Doctors usually use the TNM system to stage thyroid cancer. This is a combination of letters and numbers that describe its size and how far the cancer has spread.

  • T (tumour) – given from 1 to 4, which describes the size of the tumour
  • N (node) – given as either 0 or 1, to indicate whether the cancer has spread to nearby lymph glands
  • M (metastases) – given as either 0 or 1, to indicate whether the cancer has spread to another part of the body

Knowing the stage of your cancer will help your doctors decide on the best treatment for you.

Find out more about the TNM staging system for thyroid cancer from Cancer Research UK.

Page last reviewed: 28 August 2019
Next review due: 28 August 2022