Prompt attention to signs and symptoms is the best way to diagnose most thyroid cancers early. Thyroid cancer can cause any of the following signs or symptoms:

  •  A nodule, lump, or swelling in the neck, sometimes growing rapidly
  • Pain in the front of the neck, sometimes going up to the ears
  • Hoarseness or other voice changes that do not go away
  • Trouble swallowing
  • Breathing problems (feeling as if one were “breathing through a straw”)
  • A constant cough that is not due to a cold

If you have any of these signs or symptoms, talk to your doctor right away. Many noncancerous conditions (and some other cancers of the neck area) can cause some of the same symptoms. Thyroid nodules are common and are usually benign. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have thyroid cancer, your health care professional will want to get your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had thyroid cancer (especially medullary thyroid cancer) or tumors called pheochromocytomas, it is important to tell your doctor, as you might be at high risk for this disease. A physical exam will give your doctor more information about possible signs of thyroid

cancer and other health problems. During the exam, your doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck.

Biopsy

The actual diagnosis of thyroid cancer is made from the results of a biopsy, in which cells from the suspicious area are removed and looked at under a microscope. The simplest way to find out if a thyroid lump or nodule is cancerous is with a fine needle aspiration(FNA) of the thyroid nodule.  This type of biopsy can usually be done in your doctor’s office or clinic. Your doctor will place a thin, hollow needle directly into the nodule to take out (aspirate) cells and a few drops of fluid into a syringe. The doctor usually repeats this 2 or 3 times during the same appointment to take samples from several areas of the nodule. The cells can then be looked at under a microscope to see if they look cancerous or benign. Before the biopsy, local anesthesia (numbing medicine) may be injected into the skin over the nodule, but in some cases an anesthetic may not be needed at all. A potential complication of the biopsy is prolonged bleeding, but this is rare except in people with bleeding disorders. Be sure to tell your doctor if you have a bleeding disorder. This test is generally done on all thyroid nodules that are big enough to be felt. This means that they are larger than about 1 centimeter (about 1/2 inch) across. If a nodule is too small for the doctor to feel, sometimes FNA biopsies can be done using an ultrasound machine to help the doctor find the right place to put the needle.

About 2 tests in every 10 may need to be repeated because the sample ends up not containing enough cells. About 7 of 10 FNA biopsies will show that the nodule is benign. Cancer is clearly diagnosed in only about 1 of every 20 FNA biopsies.

Sometimes the test results come back as suspicious or atypical. This happens when the FNA findings can’t show for sure if the nodule is benign or malignant. In these cases, a more involved biopsy may be needed to get a better sample, particularly if the doctor has reason to think the nodule may be cancerous. This might include a biopsy using a larger needle or a surgical “open” biopsy or a lobectomy (removal of half of the thyroid gland). Surgical biopsies are done in an operating room while you are under general anesthesia (in a deep sleep).

Other diagnosing and confirmation methods of thyroid cancer are:

  • Imaging tests
  • Chest x-ray
  • Ultrasound, or sonography
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Nuclear medicine scans
  • Blood tests
  • Thyroid stimulating hormone (TSH)
  • T3 and T4 (thyroid hormones)
  • Thyroglobulin
  • Calcitonin
  • Carcinoembryonic antigen (CEA)