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  • How is thyroid cancer diagnosed?

    Contents

    Diagnosis

    If you have thyroid nodules, your doctor will suggest you have one or more of the following tests to work out whether the nodules could be cancer and whether you need treatment. It’s unlikely you will have all of the tests described on this page. Some of these tests can also show whether the cancer has spread to other parts of your body.

    Blood test

    Your doctor will do a blood test to check the levels of hormones (such as T3 and T4) and thyroid-stimulating hormone (TSH). A cancerous thyroid can continue to function normally so a blood test may help rule out benign thyroid conditions such as hypothyroidism or hyperthyroidism.

    If your doctor suspects you have medullary thyroid cancer the levels of calcitonin may also be checked. High calcitonin levels in the blood can be a sign of medullary thyroid cancer.

    Ultrasound

    An ultrasound uses soundwaves to produce a picture of internal organs. If you have a lump in your thyroid the ultrasound can help the doctor determine whether it is a fluid-filled cyst or a solid thyroid nodule.

    The doctor will also check if the nodule has characteristics that suggest cancer. The scan can also show if the lymph nodes (small, bean-shaped structures) in your neck are affected.

    The ultrasound scan is painless and takes about 15 to 20 minutes. A gel is spread over your neck then a handheld device called a transducer is moved over the area. The device sends out soundwaves that echo when they meet something dense like an organ or tumour. A computer changes these echoes into a picture.

    Biopsy

    If the doctor feels a nodule in your neck or sees one during an ultrasound they may suggest a fine needle aspiration (FNA) biopsy.

    During a FNA biopsy a thin needle is inserted into the nodule and a very small tissue sample is taken from the nodule for examination under a microscope. You may be given local anaesthesia (pain relief) to numb the area. Sometimes an ultrasound is used to guide the needle to the right spot. If not enough cells are removed the first time the process may be repeated.

    If it’s not possible to determine the characteristics of the nodule with a FNA the doctor may remove part of the thyroid (hemi-thyroidectomy) to help confirm the diagnosis. If thyroid cancer is found after a hemi-thyroidectomy, you may need further surgery to remove the rest of your thyroid and possibly some lymph nodes in the neck. This will depend on the size and type of cancer, and if you have nodules in the other thyroid lobe. 

    Further scans

    The following scans are sometimes used to see if the cancer has spread to other parts of your body. This process is called staging and it will help your doctors to decide on the best treatment for you. A CT scan and/or PET scan may also be repeated after surgery to check your health and how well the treatment is working.

    CT scan

    A CT (computerised tomography) scan uses x-ray beams to create a detailed three-dimensional picture of the inside of the body. 

    In most cases the ultrasound gives enough information before thyroid surgery but you may need a CT scan if your thyroid is very enlarged, if it is extending well into the chest or if there is concern that cancer has spread to other areas in the neck.

    Before the scan dye may be injected into one of your veins to help make the pictures clearer. This may make you feel hot all over and also leave a strange taste in your mouth for a few minutes.

    While it may take 30–60 minutes to prepare for the scan, especially if using dye, the scan takes a few minutes. A CT scan can be nois, but it is painless. Most people can go home as soon as the scan is over.

    PET scan

    The PET (positron emission tomography) scan may be used after surgery to work out if the cancer has come back. It’s used only if the doctor thinks the cancer needs to be viewed in a different way.

    Before the PET scan you will be asked not to eat or drink for a period of time (fast). During the scan, you will be injected with a glucose solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more of the glucose solution than normal cells.

    You will be asked to sit quietly for 30–90 minutes while the glucose solution moves around your body, then you will be scanned to create pictures of radioactive areas in the body. While it may take several hours to prepare for the test the scan itself takes only about 30 minutes. 

    Health professionals that you might see

    Your GP will arrange the first tests to assess your symptoms. This can be a worrying and tiring time especially if you need several tests. If these tests do not rule out cancer you will usually be referred to an endocrinologist or endocrine surgeon who will arrange further tests and advise you about treatment options.

    You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This multidisciplinary team (MDT) will depend on the stage of the cancer.

    Health professionals for early thyroid cancer

    endocrinologist

    specialises in diagnosing and treating disorders of the endocrine system

    endocrine surgeon

    operates on the thyroid gland, parathyroid glands,adrenal glands and the endocrine pancreas

    ENT surgeon

    treats the ears, nose and throat, including lymph nodes in the neck, and checks the vocal cords before and after surgery

    head and neck surgeon

    operates on cancer in the head and neck area

    nuclear medicine specialist

    coordinates the delivery of radioactive iodine treatment and nuclear scans

    nurses and nurse care coordinators

    support patients and families throughout treatment and liaise with other staff.

    Additional health professionals you may see

    radiation oncologist

    prescribes and coordinates the course of radiotherapy

    medical oncologist

    prescribes and coordinates the course of chemotherapy

    counsellor, social worker

    provide emotional support and link you to support services

    dietitian recommends an eating plan to follow during treatment and recovery

    This website page was last reviewed and updated March 2017.

    Information last reviewed January 2016 by:  A/Prof Julie Miller, Specialist Endocrine Surgeon, The Royal Melbourne Hospital, Epworth Freemasons and Melbourne Private Hospitals, VIC; Polly Baldwin, Cancer Council Nurse, 13 11 20, Cancer Council SA; Dr Gabrielle Cehic, Nuclear Medicine Physician, Flinders Medical Centre, Lyell McEwin Hospital and The Queen Elizabeth Hospital, SA; Dr Kiernan Hughes, Endocrinologist, San Clinic Specialist Rooms & Chatswood Rooms, Northern Endocrine Pty Ltd, NSW; Dr Chris Pyke, A/Prof of Surgery, University of Queensland, Mater Hospital, Brisbane, QLD; and Jen Young, Consumer.

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