Thyroid Cancer: Early Signs and First Appointment

“The development of lumps in the thyroid or nodules is very common,” Dr. Lisa Orloff, Director of the Endocrine Head & Neck Surgery Program at Stanford University School of Medicine, tells SurvivorNet. “The majority of nodules are benign. About 7 to 10% of thyroid nodules, however, are cancerous. And part of the challenge is identifying which nodules are cancerous compared to the majority.”

“Thyroid nodules are something that we all deal with increasingly over our lifetimes. So there’s sort of a general statistic that by the age of 50, about 50% of adults will have some thyroid nodularity, and some of that nodularity is not detectable to the individual. It’s found on imaging studies, for example,” she adds.

To detect cancer early and have a better chance of successful treatment, it’s important to be aware of signs and symptoms.

Early Signs of Thyroid Cancer

“Sometimes there could be no sign at all,” Stephanie Giparas, a Physician Assistant at the Endocrine and Head and Neck Department Moffitt Cancer Center, tells SurvivorNet.

“Sometimes the patient could go in for imaging, especially at a cancer center for just surveillance follow-up, and they could find an incidentally noted thyroid nodule. Other times when patients usually present with symptoms, usually it’s a lump on either the thyroid gland or enlarged neck lymph node.”

Here’s a breakdown of possible symptoms to be aware of:

Neck Lump or Nodule

One of the most common early signs of thyroid cancer is a lump or nodule in the neck area. You might spot this lump yourself when looking in the mirror or notice it when swallowing. Sometimes, doctors will detect it during a physical exam or imaging test done for another reason.

Thyroid nodules are typically painless. If a nodule is small, you might not notice it at all. Some nodules can grow large enough that they become visible or you can feel them with your fingertips.

Sometimes, thyroid cancer may cause lymph nodes in your neck to swell. Lymph nodes often enlarge for a variety of reasons, including infections. However, if they stay enlarged for a prolonged period without improvement, you should consult a healthcare provider.

Most nodules are actually benign (non-cancerous). Only a small percentage turn out to be thyroid cancer.

Changes in the Voice (Hoarseness)

“If somebody does have symptoms related to a thyroid cancer, that’s usually an indication that it’s a more advanced cancer,” Dr. Orloff explains.

The thyroid gland is close to your voice box (larynx). A growing thyroid nodule, particularly one pressing on the nerves controlling your vocal cords, may lead to hoarseness, persistent voice changes, or difficulty projecting your voice.

Many non-cancerous conditions, such as colds or laryngitis, can cause hoarseness as well. But if your voice remains hoarse longer than a few weeks without clear reason, a medical evaluation is a good idea.

Trouble Swallowing or Breathing

As a thyroid mass enlarges, it can press on your esophagus (the tube that carries food to your stomach) or your windpipe. This pressure might make it feel harder to swallow or breathe.

Difficulty swallowing doesn’t always mean you have thyroid cancer. Still, breathing or swallowing changes should not be ignored.

Your First Appointment With Your Healthcare Team

Once you suspect something — maybe a small lump in your neck, or persistent hoarseness — it’s time to see a healthcare provider. Many people start with either a primary care physician (such as a family doctor) or go directly to an endocrinologist, who specializes in hormone-related glands (including the thyroid). You might also see an otolaryngologist (an ENT doctor) if your main complaints involve voice changes, swallowing problems, or lumps in the neck.

“When anyone comes in and they hear the word cancer, our brain just elicits a panic mode. What does this mean for me and the long-term aspects of my life or my health?” Giparas says.

“It’s really important to talk about what the normal pathophysiology or how thyroid cancer behaves and it’s risk to them in their lifetime. If this is caught quite early, and if it’s a small tumor, a lot of patients can just undergo the surgery and they can live their whole life without any issues, except potentially surveillance to make sure that it’s completely treated.”

Before your appointment, it’s generally a good idea to prepare in the following ways:

• Gather Records: If you have had any relevant tests — like neck ultrasounds or blood tests — bring those results with you.
• Write Down Symptoms: Note anything unusual, no matter how minor. This includes changes in energy, mood, weight, appetite, voice, or swallowing.
• Family History: If possible, find out if any close relatives have had thyroid cancer or other endocrine-related conditions. This background can be crucial.

This initial appointment can be nerve-racking, but remember: your doctor or specialist is there to help you. Here are some steps typically involved in the first meeting:

• Discussion and Questions: You will have time to describe your symptoms, concerns, family history, and any relevant lifestyle factors. Don’t be shy — this is the moment for honesty and detail.
• Physical Exam: Your doctor may gently feel your neck for nodules or enlarged thyroid tissue. They might also check your lymph nodes and look for signs of difficulty swallowing or breathing.
• Blood Tests: Common tests measure levels of T3, T4, and TSH. These results will indicate if your thyroid is overactive, underactive, or functioning normally. If medullary thyroid cancer is suspected, your doctor might also check levels of calcitonin and a substance called carcinoembryonic antigen (CEA).
• Imaging: Often, an ultrasound of your thyroid and neck area will be scheduled. Ultrasound is non-invasive and can show whether nodules are solid or filled with fluid, as well as check nearby lymph nodes. In some cases, a scan using radioactive iodine helps determine if the nodules are “hot” (producing excess hormone) or “cold” (less active, with a higher chance of being cancerous).

“Ultrasound is the best method for evaluating characteristics of thyroid nodules, and there are features that are suggestive of malignant changes, and there are other features that are more reassuring and suggestive of benign changes,” Dr. Orloff explains. “However, no ultrasound can absolutely confirm or rule out a cancer. And even if suspicious changes are present, there are different cancer subtypes. So the needle biopsy is the step that follows the diagnostic ultrasound.”

Fine-Needle Aspiration (FNA) Biopsy

Your doctor may also recommend a fine-needle aspiration (FNA) biopsy.

“The needle biopsy retrieve cells from a nodule, and those cells are first examined by a pathologist for their architecture or their structure. And so most diagnoses of thyroid cancer can be made through what’s called cytopathology or looking at the cell structure and the individual nuclei within cells,” Dr. Orloff explains.

Here’s a breakdown of the FNA process:

Preparation

You’ll be asked to lie down or sit in a comfortable position. If the FNA is for your thyroid, you’ll typically lie on your back with your neck slightly extended. This position makes the area easier for the doctor to see and reach.
The skin over the area is cleansed, and sometimes a local anesthetic is applied so you won’t feel as much discomfort.

Guidance by Ultrasound

“Needle biopsies are usually done under ultrasound guidance, and so the same tool ultrasound that is used to characterize nodules is used to help target a nodule for biopsy,” Dr. Orloff explains.

Ultrasound is a safe imaging method that uses sound waves (no radiation). By using ultrasound, the doctor can clearly see the lump’s exact size and location. This helps ensure that the needle goes into the correct spot and collects the right cells.

Inserting the Needle

A thin, hollow needle — much smaller than the one used for drawing blood — is gently inserted into the lump or nodule. The doctor will move the needle in a slight back-and-forth motion to gather cells. It may feel like a small pinch or mild pressure. Most people tolerate this very well and say it’s only minimally uncomfortable.

Collecting the Cells

The needle is attached to a small syringe, and your doctor or technician may or may not need to apply gentle suction to pull cells into the syringe. The needle is usually in place for only a few seconds.

Releasing the Sample

Once enough cells or fluid have been collected, the needle is carefully removed. The sample is placed on a slide or in a container and sent to a pathology lab, where a specialist (pathologist) examines the cells under a microscope.

After the Procedure

• A small bandage may be placed over the spot where the needle went in.
• Most people can go back to their usual activities almost immediately.
• Mild soreness at the site is possible but usually goes away quickly. If the area feels tender, an over-the-counter pain reliever might help.

Questions to Ask Your Doctor

• What are the next steps if a nodule is suspected to be cancerous?
• How exactly will the FNA procedure be done, and will I feel any pain during it?
• How long does an FNA procedure usually take, and can I go back to my normal activities afterward?
• Will the procedure be guided by ultrasound or another imaging tool?
• Are there any specific risks, such as bleeding or infection, I should be aware of?

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