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