Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- palpable thyroid nodule
Other diagnostic factors
- extremes of age
- family history of thyroid cancer
- hoarseness
- dyspnoea
- dysphagia
- tracheal deviation
- cervical lymphadenopathy
- rapid neck enlargement
Risk factors
- head and neck irradiation
- female sex
- family history of thyroid cancer
Diagnostic tests
1st tests to order
- TSH
- thyroid/neck ultrasound
- fine-needle aspiration (FNA)
Tests to consider
- molecular testing of cytology specimens
- free T4
- free T3
- laryngoscopy
- I-123 thyroid scan and uptake
- core biopsy
- CT neck
- serum calcitonin
- genetic testing for familial syndromes
- serum thyroglobulin
Emerging tests
- translaryngeal ultrasound
- sentinel node biopsy
Treatment algorithm
papillary, follicular, or oncocytic
anaplastic
medullary
Contributors
Authors
Rajiv Datta, MD, FACS, FRCS, FICS
Chairman
Department of Surgery
Professor Of Surgery, Icahn School of Medicine at Mount Sinai
Chief
Division of Surgical Oncology
Chief
Division of Head and Neck Surgery
Mount Sinai South Nassau Hospital
Oceanside
NY
Disclosures
RD declares that he has no competing interests.
Peer reviewers
Rosemarie Metzger, MD, MPH, FACS
Associate Professor of Surgery, Endocrine Surgery Division
Banner - University Medical Center
Phoenix
AZ
Disclosures
RM declares that she has no competing interests.
Lindsay Bischoff, MD
Associate Professor
Medical Director Vanderbilt Thyroid Center
Vanderbilt University Medical Center
Nashville
TN
Disclosures
LB declares that she has no competing interests.
F. Fausto Palazzo, MS, FRCS
Consultant Endocrine Surgeon
Hammersmith & Charing Cross Hospitals
Clinical Lead for Endocrine Surgery
Honorary Senior Lecturer
Imperial College
London
UK
Disclosures
FFP declares that he has no competing interests.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma [internet publication].Full text
European Society for Medical Oncology. Clinical practice guidelines - thyroid cancer. 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Benign thyroid nodule
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: thyroid carcinoma
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