Micrograph of a lymph node with papillary thyroid carcinoma After a thyroid nodule is found during a physical examination, a referral to an endocrinologist or a thyroidologist may occur. Most commonly, an ultrasound is performed to confirm the presence of a nodule and assess the status of the whole gland. Some ultrasound results may report a TI-RADS or TIRADS score to categorize the risk of malignancy. Measurement of thyroid stimulating hormone, free and/or total triiodothyronine (T3) and thyroxine (T4) levels, and antithyroid antibodies will help decide if a functional thyroid disease such as Hashimoto's thyroiditis is present, a known cause of a benign nodular goiter. a thyroid scan, performed often in conjunction with a radioactive iodine uptake test may be used to determine whether a nodule is "hot" or "cold" which may help to make a decision whether to perform a biopsy of the nodule. Measurement of calcitonin is necessary to exclude the presence of medullary<unk> . Finally, to achieve a definitive diagnosis before deciding on treatment, a fine needle aspiration cytology test may be performed and reported according to the Bethesda system. After diagnosis, to understand potential for spread of disease, or for follow up monitoring after surgery, a whole body I-131 or I-123 radioactive iodine scan may be performed. In adults without symptoms, screening for<unk>  is not recommended. Classification Pie chart of<unk>  types by incidence.<unk> s can be classified according to their histopathological characteristics. These variants can be distinguished (distribution over various subtypes may show regional variation): * Papillary<unk>  (75 to 85% of cases) – is more often diagnosed in young females compared to other types of<unk>  and has an excellent prognosis. It may occur in women with familial adenomatous polyposis and in patients with Cowden syndrome. A follicular variant of papillary<unk>  also exists. * Newly reclassified variant: noninvasive follicular thyroid neoplasm with papillary-like nuclear features is considered an indolent tumor of limited biologic potential. * Follicular<unk>  (10 to 20% of cases) – occasionally seen in people with Cowden syndrome. Some include Hürthle cell carcinoma as a variant and others list it as a separate type. * Medullary<unk>  (5 to 8% of cases) –<unk>  of the parafollicular cells, often part of multiple endocrine neoplasia type 2. * Poorly differentiated<unk>  * Anaplastic<unk>  (1 to 2%) is not responsive to treatment and can cause pressure symptoms. * Others * Thyroid lymphoma * Squamous cell thyroid carcinoma * Sarcoma of thyroid * Hürthle cell carcinoma The follicular and papillary types together can be classified as "differentiated<unk> ". These types have a more favorable prognosis than the medullary and undifferentiated types. * Papillary microcarcinoma is a subset of papillary<unk>  defined as a nodule measuring less than or equal to 1 cm. 43% of all<unk> s and 50% of new cases of papillary thyroid carcinoma are papillary microcarcinoma. Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to lobectomy or observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having<unk> . Woolner et al. first arbitrarily coined the term "occult papillary carcinoma", in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter. Staging<unk>  staging is the process of determining the extent of the development of a<unk> . The TNM staging system is usually used to classify stages of<unk> s, but not of the brain. File:Diagram showing stage M1<unk>  CRUK 241.Stage M1<unk>  File:Diagram showing stage N1a<unk>  CRUK 242.Stage N1a<unk>  File:Diagram showing stage N1b<unk>  CRUK 243.Stage N1b<unk>  File:Diagram showing stage T1a<unk>  CRUK 250.Stage T1a<unk>  File:Diagram showing stage T1b<unk>  CRUK 251.Stage T1b<unk>  File:Diagram showing stage T2<unk>  CRUK 258.Stage T2<unk>  File:Diagram showing stage T3<unk>  CRUK 265.Stage T3<unk>  File:Diagram showing stage T4a<unk>  CRUK 272.Stage T4a<unk>  File:Diagram showing stage T4b<unk>  CRUK 273.Stage T4b<unk>  Metastases Detection of differentiated<unk>  metastasis may be detected by performing a full-body scintigraphy using iodine-131. Spread<unk>  can spread directly, via lymphatics or blood. Direct spread occurs through infiltration of the surrounding tissues. The tumor infiltrates into infrahyoid muscles, trachea, oesophagus, recurrent laryngeal nerve, carotid sheath, etc. The tumor then becomes fixed. Anaplastic carcinoma spreads mostly by direct spread, while papillary carcinoma spreads so the least. Lymphatic spread is most common in papillary carcinoma. Cervical lymph nodes become palpable in papillary carcinoma even when the primary tumor is unpalpable. Deep cervical nodes, pretracheal, prelaryngeal, and paratracheal groups of lymph nodes are often affected. The lymph node affected is usually the same side as that of the location of the tumor. Blood spread is also possible in<unk> s, especially in follicular and anaplastic carcinoma. The tumor emboli do angioinvasion of lungs; end of long bones, skull, and vertebrae are affected. Pulsating metastases occur because of their increased vascularity.
Thyroid cancer
Metastasis
Papillary thyroid cancer
Thyroid nodule
Thyroid lymphoma
Medullary thyroid cancer
Thyroid neoplasm
Follicular thyroid cancer