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Diagnostics of thyroid cancer

Primary work-up

  • Thorough family anamnesis 
  • Clinical examination with inspection and palpation of the thyroid gland and neck.
  • Register sign of hyper/hypothyroidism.
  • Blood tests:
    • thyroid function including thyroid stimulating hormone (TSH) and free T4
    • anti TPO (thyroid antibody - positive for autoimmune thyroiditis)
    • s-calcium and s-albumin

If there is suspicion of malignancy, the patient should have a work-up performed by a specialist.

Ultrasound examination, other image diagnostics, or scintigraphy will delay and raise the price of the work-up for possible thyroid cancer, and should only be done in cooperation with a specialist. 

Work-up with specialist

Patients with normal thyroid function tests with a solitary node, suspect node in nodal struma, or change in detected nodal struma, should be referred to a specialist.

Triple diagnostics are performed consisting of:

  • clinical examination
  • image diagnostics - ultrasound examination
  • biopsy - fine needle cytology

Clinical examination    

  • Anamnesis and clinical examination
  • Examination of the vocal cords, if necessary

Image diagnostics

  • Ultrasound of the thyroid gland and neck with lymph node status.

In some cases, it may be necessary to carry out a MRI or CT if:

  • there are large strumas where the limits cannot be assessed well enough clinically or by ultrasound.
  • there are fixed tumors
  • there is suspicion of extensive cancer 

Thyroid scintigraphy is only performed in patients with low/suppressed TSH and for suspect autonomous adenoma.

At least two months should pass after iodine-containing contrast is given until testing or treatment with radioactive iodine (131I). Therefore, the use of iodine-containing contrast agents for CT should be avoided before testing or treatment with radioactive iodine.

Biopsy - fine needle cytology

An open biopsy should not be taken of the primary tumor or lymph nodes suspect for metastases if there is suspicion of thyroid cancer. A cytological or histological needle biopsy is ordinarily sufficient.

If there is suspicion of lymphoma or undifferentiated thyroid carcinoma, an open biopsy may be necessary if a core biopsy is indeterminate.

Routine testing for calcitonin in patients with a node in the thyroid gland is controversial, but should be done preoperatively in those to be operated, or where there is a clinical suspicion of medullary thyroid carcinoma.  

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