How thyroid cancer is diagnosed

If your GP thinks that you may have cancer, or if they’re not sure what the problem is, they’ll refer you to a hospital for specialist advice and treatment|.

To help GPs, the National Institute for Health and Clinical Excellence| (NICE) has produced referral guidelines.

The guidelines state that your GP should refer you for an immediate appointment if you have difficulty swallowing or breathing because of a swollen thyroid.

The guidelines also recommend that your GP should refer you for an urgent appointment if you have thyroid swelling and any of the following:

• a history of radiotherapy treatment to the neck
• people in your family have had endocrine tumours
• a lump in the neck that is getting bigger
• an unexplained hoarse voice that doesn’t go away
• are very young (before puberty)
• you’re over 65.

An urgent referral means that you should be seen at the hospital within two weeks.

At the hospital

The specialist will ask you about your general health and any previous medical problems before they examine you. You may have some of the following tests:

Blood tests

Samples of blood will be taken to check your thyroid hormone| and TSH levels. The level of calcitonin in your blood may also be checked. Calcitonin is one of the hormones produced by the thyroid, and the amount of calcitonin in the blood can be used to help diagnose medullary thyroid cancer. Your blood will also be tested to check your general health.

Ultrasound thyroid scan

An ultrasound scan uses sound waves to make up a picture of the inside of the neck and the thyroid.

During the ultrasound scan, the doctor will also check the lymph nodes in your neck to see if any are abnormal. This is because papillary thyroid cancer can often spread to the lymph nodes. This may affect your treatment.

Once you’re lying comfortably on your back, a gel is spread over your neck. A small device like a microphone, which produces sound waves, is then moved over the area. The sound waves are changed into a picture by a computer.

Fine needle aspiration

A doctor will gently pass a small needle into the swelling in your neck. Sometimes the doctor will use an ultrasound scanner to help guide the needle to the right area. They’ll then take a small sample of cells and examine it under a microscope to check whether there are cancer cells present.

Core biopsy

Very occasionally it may be necessary to do a surgical biopsy, which is done under a general anaesthetic. The doctor will make a small cut in the skin close to the thyroid and remove a small sample of the thyroid gland. You may have a surgical biopsy if:

• it isn’t possible to do a fine needle aspiration
• the fine needle aspiration doesn’t collect enough cells
• the doctor who looks at the cells under the microscope
• (a pathologist), isn’t sure whether cancer cells are present from the fine needle aspiration or biopsy sample.