History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include head and neck irradiation and female sex.
palpable thyroid nodule
Thyroid cancer most commonly presents as an asymptomatic thyroid nodule detected on physical examination (palpation) or ultrasound in women in their 30s or 40s.
The risk of malignancy in a cold (hypofunctioning) nodule in a multinodular goitre is approximately 5% to 8%, similar to that of solitary cold nodules.[29]
Other diagnostic factors
common
uncommon
family history of thyroid cancer
Responsible for a small number of cases.
Approximately 25% of medullary thyroid cancers (MTC) are hereditary.[28]
Hereditary MTC can occur as a component of multiple endocrine neoplasia (MEN) type 2A (MEN2A) or MEN2B, or can occur in an isolated familial form.[4]
Rarely, papillary thyroid cancer is familial.[29]
hoarseness
May be present in locally advanced disease. Suggests recurrent laryngeal nerve involvement.
Results from paralysis of ipsilateral vocal cord. Other causes should be ruled out.[29]
dyspnoea
May be present in locally advanced disease.
Results from tracheal pressure. Other causes should be ruled out.[29]
dysphagia
May be present in locally advanced disease.
Results from oesophageal pressure. Other causes should be ruled out.[29]
tracheal deviation
Caused by an enlarged thyroid gland. Can also be due to a large benign goitre.
cervical lymphadenopathy
Suggests neck metastasis.
A common presentation of medullary thyroid cancer.[14]
Risk factors
strong
head and neck irradiation
Radiation may have been previously given for treatment of another malignancy.
Accidental exposure may have occurred due to nuclear accidents, such as at Chernobyl and Fukushima.[32][36]
Older patients may have a remote history of radiation treatment for acne, thymic enlargement, or lymphadenopathy.
A significant risk factor for malignant thyroid nodules when exposure is in youth (<16 years), but not common.
female sex
Incidence rates of thyroid cancer are approximately three times higher in women than in men.[17]
In the US, the lifetime probability of developing invasive thyroid cancer is 1.8% (1 in 55) for women and 0.7% (1 in 149) for men.[18]
Although thyroid cancer is more common in women, men have a higher risk of malignancy in thyroid nodules.[29]
weak
family history of thyroid cancer
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