Early thyroid cancer often does not have symptoms. But as the cancer grows, symptoms may include:
- Hoarseness or voice changes
- Swollen lymph nodes in the neck
- Trouble swallowing or breathing
- Pain in the throat or neck that does not go away
Most often, these symptoms are not due to cancer. An infection, a benign goiter, or another health problem is usually the cause of these symptoms. Anyone with symptoms that do not go away in a couple of weeks should see a doctor to be diagnosed and treated as early as possible.
If you have symptoms that suggest thyroid cancer, your doctor will help you find out whether they are from cancer or some other cause. Your doctor will ask you about your personal and family medical history. You may have one or more of the following tests:
Physical exam: Your doctor feels your thyroid for lumps (nodules). Your doctor also checks your neck and nearby lymph nodes for growths or swelling.
Blood tests: Your doctor may check for abnormal levels of thyroid-stimulating hormone (TSH) in the blood. Too much or too little TSH means the thyroid is not working well. If your doctor thinks you may have medullary thyroid cancer, you may be checked for a high level of calcitonin and have other blood tests.
Ultrasound: An ultrasound device uses sound waves that people cannot hear. The device aims sound waves at the thyroid, and a computer creates a picture of the waves that bounce off the thyroid. The picture can show thyroid nodules that are too small to be felt. The doctor uses the picture to learn the size and shape of each nodule and whether the nodules are solid or filled with fluid. Nodules that are filled with fluid are usually not cancer. Nodules that are solid may be cancer.
Thyroid scan: Your doctor may order a scan of your thyroid. You swallow a small amount of a radioactive substance, and it travels through the bloodstream. Thyroid cells that absorb the radioactive substance can be seen on a scan. Nodules that take up more of the substance than the thyroid tissue around them are called "hot" nodules. Hot nodules are usually not cancer. Nodules that take up less substance than the thyroid tissue around them are called "cold" nodules. Cold nodules may be cancer.
CT scan or MRI: Sometimes, a CT scan is needed to determine whether the cancer has invaded the trachea and to visualize the extent of lymph node involvement. Occasionally, MRI is also used to evaluate the spread of thyroid cancer.
Biopsy: A biopsy is the only sure way to diagnose thyroid cancer. A pathologist checks a sample of tissue for cancer cells with a microscope.
Your doctor may take tissue for a biopsy in one of two ways:
Fine-needle aspiration (FNA): Most people have this type of biopsy. Your doctor removes a sample of tissue from a thyroid nodule with a thin needle. An ultrasound device can help your doctor see where to place the needle.
Surgical biopsy: If a diagnosis cannot be made from fine-needle aspiration, a surgeon removes the whole nodule during an operation. If the doctor suspects follicular thyroid cancer, surgical biopsy may be needed for diagnosis.
Adapted from the National Cancer Institute and the National Institute of Health.