Other presentations
Malignant thyroid nodules may be incidentally found on neck ultrasound, positron emission tomography (PET) scan, or computed tomography (CT) scan, or may occur in multinodular goiters.[12]Bertagna F, Treglia G, Piccardo A, et al. Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab. 2012 Nov;97(11):3866-75.
https://academic.oup.com/jcem/article/97/11/3866/2836408
http://www.ncbi.nlm.nih.gov/pubmed/22904176?tool=bestpractice.com
Occasionally, patients present with advanced disease. They will have hoarseness, dyspnea, dysphagia, or cough.[1]Haugen BR, Alexander EK, Bible KC, et al; American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133.
https://www.liebertpub.com/doi/10.1089/thy.2015.0020
http://www.ncbi.nlm.nih.gov/pubmed/26462967?tool=bestpractice.com
Rapidly growing neck mass or rapid transformation of a long-standing goiter within a few days to a few weeks is characteristic of anaplastic thyroid cancer.[3]Jannin A, Escande A, Al Ghuzlan A, et al. Anaplastic thyroid carcinoma: an update. Cancers (Basel). 2022 Feb 19;14(4):1061.
https://www.mdpi.com/2072-6694/14/4/1061
http://www.ncbi.nlm.nih.gov/pubmed/35205809?tool=bestpractice.com
[13]Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2021 Mar;31(3):337-86.
https://www.liebertpub.com/doi/10.1089/thy.2020.0944
http://www.ncbi.nlm.nih.gov/pubmed/33728999?tool=bestpractice.com
Cervical lymphadenopathy is a common presentation of medullary thyroid cancer.[14]Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet. 2016 Dec 3;388(10061):2783-95.
http://www.ncbi.nlm.nih.gov/pubmed/27240885?tool=bestpractice.com
Uncommonly, patients have a multiple endocrine neoplasia (MEN) syndrome.[4]Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610.
https://www.liebertpub.com/doi/10.1089/thy.2014.0335
http://www.ncbi.nlm.nih.gov/pubmed/25810047?tool=bestpractice.com
Rarely, the thyroid itself is involved by distant metastasis from lung, breast, melanoma, or kidney tumors, or by direct extension from malignancies in the larynx and pharynx. Also rarely, thyroid cancer presents with distant lung or bone metastasis or pathologic bone fracture. Very rarely, thyroid cancer causes thyrotoxicosis.[15]Phillips JS, Pledger DR, Hilger AW. Rapid thyrotoxicosis in anaplastic thyroid carcinoma. J Laryngol Otol. 2007 Jul;121(7):695-7.
http://www.ncbi.nlm.nih.gov/pubmed/17156585?tool=bestpractice.com