How Thyroid Cancer is Diagnosed

There are Thyroid cancers by be found by a patient who notices a lump in the neck, identified during a routine physical exam by their physician, or incidentally imaged during an imaging test done for other reasons. Medullary thyroid cancer can run in families as autosomal dominant syndromes called either multiple endocrine neoplasia. If a family member has medullary thyroid cancer and has a positive genetic test for these syndromes then other family members may be asked to be screened for thyroid nodules.

Blood tests are not used to diagnose thyroid cancers. Blood testing is done to determine the function of the thyroid gland. An ultrasound (test that uses sound waves to create electronic pictures of internal organs) is the best imaging test to evaluate the structure of the thyroid gland. This testing is performed by the specialists in the office at Houston Thyroid and Endocrine. An ultrasound can determine the size, location and number of tumors, find for lymph nodes in the neck that might have cancer in them. Additional diagnostic tests may include a computerized tomography (CT) scan or a thyroid scan. A magnetic resonance imaging (MRI) may be done but is not part of the routine initial evaluation.

None of the imaging tests we have can determine if a thyroid nodule is malignant. If a nodule is found in the thyroid you physician will usually obtain a small tissue sample from the thyroid gland before treatment to determine if cancer is present or not. We perform this procedure in our thyroid nodule clinic. The results from this procedure show what treatment is necessary, if any. The biopsy is obtained during a simple outpatient procedure called fine needle aspiration (FNA).

1. Only 1000-2000 deaths/year, but most need long term follow up

2. The finding of a thyroid nodule by your physician is not an emergency.

3. 400,000+ thyroid cancer patients are alive in the USA.

4. The painless nodule or enlarged thyroid may be the only sign or symptom.

5. Only 5% of all nodules are cancer.

6. A Family history of thyroid cancer and radiation therapy are risk factors for having a thyroid cancer.

7. High frequency thyroid ultrasound is the best screening test.

8. Complete thyroid evaluation by an endocrinologist before surgery to get a good outcome.

9. Ultrasound guided Fine Needle Biopsy with new genetic testing, by an expert thyroid ultrasonographer is helpful for accuracy. The best place to aim the needle can only be seen with ultrasound.

10. Consider requesting an outside expert second opinion. Thyroid biopsies are hard to read even by most well trained pathologists.

11. If it is cancer, request pre-surgery ultrasound lymph node mapping. This will help in planning your first surgery. Remember, this is a new indication for the ultrasound, so you have to insist that it be done. It can save you another surgery in the future.

12. Request an biopsy of the nodes, and a washing for cancer markers.

13. If positive for a cancer node, make sure the surgeon adds that neck area to the original surgery plan.

14. Request a pre-surgery cancer marker.

15. The cancer markers are thyroglobulin for papillary and follicular.

16. Calcitonin is the marker for Medullary thyroid cancer.

17. Ask for a thyroid surgeon. He must operate at least 50-150 times on the thyroid a YEAR.

18. Radioiodine is not an emergency therapy. Take your time to decide if it is really necessary