Thyroid Cancer Diagnosis

Physical Examination

The doctor first gathers detailed information from the patient. Patient complaints and family history are particularly valuable for diagnosis. Following this, a physical examination is conducted. After the physical examination, thyroid cancer can be diagnosed through appropriate imaging and biopsy methods, and a suitable treatment plan is determined.

 

 

Blood Tests

This is a fundamental step in patient evaluation, providing valuable data. Numerous parameters, including TSH, T3, T4, thyroglobulin, and calcium, are assessed, particularly the hormones secreted by the thyroid gland. These tests are important not only for diagnosing thyroid cancer but also for identifying other thyroid conditions.

Imaging Tests

Several imaging tests can be used to diagnose thyroid cancer and determine whether it has spread to other parts of the body. The most common imaging methods include ultrasound, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI).

Ultrasound

Thyroid ultrasound is often considered a part of the physical examination by many doctors. It helps determine whether a detected nodule is cystic or solid. It shows the number and size of nodules and provides information to help doctors decide whether a biopsy is needed. If a biopsy is required, ultrasound assists in locating the nodule during the procedure.

Scintigraphy

Radioisotope imaging is a nuclear scanning method. While ultrasound provides information about the structure and location of a nodule, scintigraphy offers functional data about the nodule. A radioactive substance is administered to the patient orally or via injection, and scanning is performed. Nodules that absorb more radioactive iodine appear prominent in the scan and are referred to as “hot nodules,” which are more likely to be benign. Nodules showing less radioactivity are called “cold nodules” and have a higher likelihood of being malignant compared to hot nodules.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

CT is one of the methods that can be used to evaluate the thyroid. It is not frequently used, as it cannot detect small nodules but helps in detecting larger nodules and determining whether thyroid cancer has spread to other areas of the body.

Similarly, MRI can help identify the size of a thyroid nodule and its relationship with surrounding tissues.

Biopsy

After physical examination, blood, and imaging tests, the doctor may decide to perform a biopsy. The fine-needle aspiration (FNA) biopsy method is used for thyroid nodules. In some cases, a biopsy decision may be made solely for diagnostic or therapeutic purposes without using blood and imaging tests. Biopsies are usually not required for nodules smaller than 1 cm or purely cystic nodules. However, if the small nodule is deemed risky for thyroid cancer, a biopsy is performed. Additionally, purely cystic nodules can be aspirated for treatment purposes even if not for biopsy.

 

 

FNA biopsy is generally a straightforward procedure and does not require an operating room. FNA biopsy involves advancing the needle into the nodule under ultrasound guidance and taking samples. These samples are examined under a microscope by a pathologist to determine whether the nodule is malignant or benign.

Genetic and Molecular Tests

Family history provides valuable insights for diagnosing thyroid cancer. Certain genetic mutations are risk factors for developing thyroid cancer. Specifically, genetic tests may be required for medullary thyroid cancer.

 

 

In recent years, various molecular tests have been developed for cell samples obtained from thyroid nodules. These tests help doctors decide whether a thyroid nodule is benign or malignant, thus determining whether surgical treatment is necessary. The Afirma test is preferred for ruling out thyroid cancer, while the ThyGenX and ThyroSeq tests are used to confirm a thyroid cancer diagnosis.