How thyroid cancer is diagnosed

If your GP thinks that cancer may be present, or is not sure what the problem is, they will 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 thyroid swelling.

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

• a history of neck irradiation
• a family history of endocrine tumours
• a lump in the neck that is increasing in size
• unexplained hoarseness
• are very young or over 65.

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

At the hospital Back to top

At the hospital the specialist will ask you about your general health and any previous medical problems before they examine you. 

Blood tests Back to top

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 Back to top

Sound waves are used to make up a picture of the inside of the neck and the thyroid.

Once you are lying comfortably on your back, a gel is spread over your neck. A small device like a microphone, which produces sound waves, is then rubbed over the area. The sound waves are changed into a picture by a computer and may show whether the lump is solid or just fluid in a cyst. 

Fine-needle aspiration Back to top

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

Very occasionally it may be necessary to do a surgical biopsy, which is done under either a local or 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 needle aspiration
• the 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 needle aspiration or biopsy sample.