Thyroid Cancer Symptoms
Most thyroid cancers present as asymptomatic thyroid nodules discovered incidentally on imaging or physical examination, rather than through specific symptoms. 1, 2
Common Presentations
Asymptomatic Nodules (Most Common)
- The majority of thyroid cancers are detected as incidental thyroid nodules during routine examination or imaging studies (ultrasound, CT, MRI, or PET scans performed for unrelated reasons) 1, 3
- Papillary thyroid carcinoma, which accounts for the vast majority of thyroid cancers, typically presents as an asymptomatic upper pole thyroid nodule 4, 5
- Approximately 30% of patients with papillary thyroid cancer have cervical lymph node metastases at presentation, which may be palpable 5
Symptomatic Presentations (Less Common)
Local compressive symptoms occur in a minority of patients and include:
- Dysphagia (difficulty swallowing) 4, 6
- Dysphonia (voice changes) 4
- Dyspnea (difficulty breathing) 4
- Stridor (high-pitched breathing sound) 4
- Hoarseness 4
- Cough 4
- Palpable neck mass 4, 3
These compressive symptoms are reported by approximately 15% of patients with sporadic medullary thyroid carcinoma at initial presentation 4
Aggressive Subtypes with Distinct Presentations
Anaplastic Thyroid Cancer
Anaplastic thyroid cancer presents dramatically with a rapidly enlarging, hard neck mass and severe compressive symptoms 4, 6:
- Large, hard mass invading the neck structures 4
- Dyspnea, cough, vocal cord paralysis (30% of patients), dysphagia, and hoarseness 4
- Palpable cervical metastases in 40% of patients at examination 4
- Distant metastases (lungs, bones, liver, brain) present in approximately 50% at diagnosis 4
Medullary Thyroid Carcinoma
- Typically presents with upper pole thyroid nodules 4
- Metastatic cervical adenopathy appears in approximately 50% of patients at initial presentation 4
- Advanced disease may cause diarrhea, Cushing's syndrome, or facial flushing due to secretion of calcitonin, ACTH, or calcitonin-gene related peptide 4
- Symptoms from distant metastases (lungs or bones) occur in 5-10% of patients 4
Important Clinical Caveats
- Vocal cord paralysis in the setting of a thyroid nodule is a red flag for malignancy with extrathyroidal extension 7
- Thyroid nodules are approximately 4 times more common in women than men, and palpable nodules increase in frequency throughout life 4
- Only 5-10% of thyroid nodules that come to medical attention are actually carcinomas 3
- The dramatic increase in thyroid cancer diagnoses over recent decades is largely attributable to incidental detection of small, asymptomatic tumors on imaging, not an increase in symptomatic disease 1, 8