Thyroid Cancer: Diagnosis and Treatment

Diagnosis

Evaluation should begin with testing for thyroid stimulating hormone (TSH) to rule out hyperthyroidism or hypothyroidism.

Fine–needle aspiration biopsy is the best diagnostic test.

Ultrasound may detect nodules and distinguish solid from cystic lesions.

Radioactive iodine uptake scan (thyroid scintigraphy) evaluates whether a nodule takes up iodine to distinguish functioning thyroid nodules (those that produce thyroid hormone) from nonfunctioning nodules. Functioning nodules are rarely malignant. Nonfunctioning nodules may be malignant and require a fine–needle aspiration biopsy.

Serum calcitonin concentration may be elevated in medullary carcinomas.

Treatment

Thyroidectomy is the primary therapy for most thyroid cancers. Resection may then be followed by postoperative radioactive iodine ablation of residual thyroid tissue and potential metastases.

Lifelong thyroid hormone replacement therapy is necessary for all surgical patients.

Treatment may include radiation and chemotherapy as an adjuvant to surgery or for palliation, primarily for patients with medullary or anaplastic thyroid cancer.¹