Thyroid cancer usually shows up as a painless lump in the neck, and most cases are papillary cancer with an excellent outlook. Less common types are follicular, medullary and anaplastic; the last one is rare but very aggressive.
Key symptoms
- Painless lump in the front of the neck
- Swollen lymph nodes in the neck
- Hoarse voice
- Trouble swallowing or breathing in advanced disease
- Usually normal thyroid function
What you find on exam
- Nodule size, firmness and mobility
- Neck lymph nodes
- Voice quality; laryngoscopy if hoarse
- Risk factors: head or neck radiation in childhood, family history
- Signs of MEN2 if medullary cancer is suspected
Tests
- TSH first
- Neck ultrasound to grade the nodule
- Fine needle aspiration biopsy based on ultrasound criteria
- Calcitonin for medullary cancer; thyroglobulin for follow-up after surgery
Treatment basics
- Surgery: lobectomy or total thyroidectomy
- Radioactive iodine for selected higher-risk patients
- Levothyroxine for replacement, with TSH suppression when needed
- Active surveillance for some very small papillary cancers
- Targeted drugs for advanced disease
Red flags
- Rapidly growing hard neck mass
- Stridor or trouble breathing
- Low calcium after thyroid surgery
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.