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Diagnosis of thyroid cancer

The doctor will first run a thyroid ultrasound scan to specifically distinguish between a cyst and a solid lump; the ultrasound will also serve to tell if the thyroid is a goitrous gland within which the lump that has brought the patient to medical attention is just a prominent one of many nodules, the so-called multinodular goitre (which is rarely a malignant condition).

 

An isotope scan will inform the doctor as to whether the nodule is functioning like a normal thyroid gland, which is very rare indeed in cancers.

 

Next, the doctor may opt to obtain needle cytology of the lump (were a fine needle is placed within the lump and tissue aspirated for examination under the microscope). If this test demonstrates cancer (carcinoma or lymphoma) then it is a useful test. However, a negative result is less reliable at excluding thyroid carcinoma as some cancers look very similar indeed to the normal thyroid tissue and the sample obtained at cytology is often inadequate to distinguish.

 

Where doubt exists the patient is usually put up for surgery and a formal hemi-thyroidectomy is performed where the half of the thyroid containing the lump is removed. If it contains differentiated thyroid cancer (see below) then a completion thyroidectomy (the removal of the rest of the gland) is performed at a subsequent operation a couple of weeks later.


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