Fast Five Quiz: Thyroid Cancer Practice Essentials

Elwyn C. Cabebe, MD

Disclosures

October 01, 2020

Thyroid carcinoma most commonly manifests as a painless, palpable, solitary thyroid nodule. Patients or physicians discover most of these nodules during routine palpation of the neck. Most palpable thyroid nodules represent benign disease. Palpable and nonpalpable nodules of similar size have the same risk for malignancy.

The patient's age at presentation is important because solitary nodules are most likely to be malignant in patients older than 60 years and those younger than 30 years. In addition, thyroid nodules are associated with an increased rate of malignancy in male individuals. Growth of a nodule may suggest malignancy. Rapid growth is an ominous sign.

Malignant thyroid nodules are usually painless. Sudden onset of pain is more strongly associated with benign disease, such as hemorrhage into a benign cyst or subacute viral thyroiditis, than with malignancy.

Hoarseness suggests involvement of the recurrent laryngeal nerve and vocal fold paralysis. Dysphagia may be a sign of impingement of the digestive tract. Heat intolerance and palpitations suggest autonomously functioning nodules.

Medullary carcinoma can occur as part of multiple endocrine neoplasia 2A or 2B syndrome, as well as familial medullary thyroid cancer. Patients with a family history of thyroid cancer should be evaluated with vigilance.

Physical examination should include thorough head and neck examination with careful attention to the thyroid gland and cervical soft tissues, as well as indirect laryngoscopy.

Solitary thyroid nodules can vary from soft to hard. Hard and fixed nodules are more suggestive of malignancy than supple mobile nodules are. Thyroid carcinoma is usually nontender to palpation. Firm cervical masses are highly suggestive of regional lymph node metastases. Vocal fold paralysis implies involvement of the recurrent laryngeal nerve.

Read more about the presentation of thyroid cancer.

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