Thyroid cancer warning signs.
1. Thyroid nodule:
The most common presentation of thyroid cancer is a nodule in the thyroid gland. Cancerous nodules tend to be harder, more fixed, larger and more irregular than non cancerous nodules.
Thyroid cancer is also highly likely in a patient who has a thyroid nodule and has:
Thyroid cancer lymph nodes are frequently cystic and can often appear lower in the neck than metastases from other head and neck primary sites. The nodes are usually large, round and have loss of the normal architecture. The appearance on ultrasound often mimics the appearance of the primary thyroid cancer and punctate echogenic foci (PEF) appearing as small bright flecks can often be seen.
3. Hoarse Voice:
Less commonly thyroid cancer can invade surrounding structures and the most common structure is the recurrent laryngeal nerve that supplies muscles of the voice box. This can lead to a breathy and hoarse voice.
4. Haemoptysis (coughing up blood):
The trachea (windpipe) is next most commonly involved and invasion of this can lead to bleeding
5. Stridor (noisy breathing) and shortness of breath:
Also caused by tracheal invasion
6. Dysphagia (difficulty swallowing):
Invasion of the oesophagus can lead to increasing difficulty swallowing. This is relatively uncommon and usually the muscle of the oesophagus is involved and not the mucosal lining
7. Family history of thyroid cancer:
A patient with a strong family history of thyroid cancer and a nodule has a higher risk of thyroid cancer. Particularly in medullary thyroid cancer. This is far less of an issue in papillary thyroid cancer unless there are 3 first degree relatives in a family with the diagnosis
8. History of radiation to neck:
A patient with a thyroid nodule and a history of previous therapeutic or environmental radiation exposure particularly in childhood is at much higher risk of having thyroid cancer. Populations who live in iodine deficient areas and around volcanoes are also at much higher risk of thyroid cancers.
9. Ultrasound risk features:
A thyroid nodule that is solid, hypoechoic ( darker on ultrasound), an irregular margin, taller than wide in shape and has multiple punctate echogenic foci is high risk for being a thyroid cancer. These features are used in scoring systems that are used as risk assessment tools for thyroid nodules to determine which should be biopsied or observed and which can be ignored. One such system in common use in Auckland is the TIRADS system.
Patients with a thyroid nodule and persistent diarrhoea may have medullary thyroid cancer with an elevated calcitonin level that leads to the diarrhoea. These patient will also usually have an elevated CEA level which is a non specific marker for cancer.
Any patients with these features should be referred early for assessment with Examination, laryngeal endoscopy, ultrasound and FNA biopsy all available in one stop in Dr Chaplin’s practice at Mauranui Clinic