It is the most common endocrine neoplasm. Most of the nodules arising in the thyroid gland are benign and only about 5-10% of those getting medical attention are carcinomas. A nodule which is cold on scan is more likely to be malignant; nevertheless, the majority of cold nodules are benign as.

When to suspect thyroid cancer?

• Thyroid nodule in a young < 20 years or old >70 years person.

• Sudden increase in the size of a thyroid nodule with pain, tenderness.

• Recent changes in voice, breathing or swallowing.

• Family history of thyroid cancer.

• Fixation to underlying structures

What are the tests done to diagnose thyroid cancer?

• Laboratory investigations

  • Thyroid function tests are usually normal in the presence of a thyroid nodule and presence of hypo/ hyperthyroidism favors a benign nodule.

  • Thyroglobulin levels are useful prognostic markers once thyroid cancer is diagnosed.

• Ultrasound of the neck

  • Guides fine needle biopsy when necessary

  • Identify solid nodules as small as 3 mm and cystic nodules as small as 2 mm. A mixed nodule is more suspicious of cancer.

• FNAC (Fine needle aspiration cytology)

  • Needle is placed into the nodule and cells are aspirated into a syringe. The cells are placed on a microscope slide, stained, and examined by a pathologist. The nodule is then classified as nondiagnostic, benign, suspicious or malignant.

• Isotope scan

  • Radionucleide scan will help in differentiating a thyroid nodule as either a cold or hot nodule. Up to 10% of cold nodules are malignant.

What are the treatment options?

1. Surgery – Once diagnosed surgery is a must to remove the nodule/ entire thyroid gland. The lymph nodes in the neck are assessed to see if they need to be removed also.

2. About 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment. This is very simple and consists of taking a single pill. The pill will contain the radioactive iodine in the dose that has been calculated for that individual. This will destroy the thyroid cells those are left out after surgery.

3. After this we start on thyroid tablet.

What is the follow-up required?

• Clinical follow up at frequent intervals is a must.

• Thyroid function tests we do from time to time to see the amount of thyroid patient should take.

• Thyroglobulin - A high serum thyroglobulin level that had previously been low following total thyroidectomy is virtually indicative of recurrence. A value of greater than 10 ng/ml is often associated with recurrence even if an iodine scan is negative.