Diagnosing Thyroid Cancer

Support Throughout the Diagnostic Process

Our physicians, nurses and support staff are here to advise you, listen to you and calm your fears. Your physicians will explain your diagnosis and compassionately offer suggestions for treatment and care. They’re here for you.

Also available for counsel, support and guidance are nurse coordinators, oncology social workers and a pastoral team. They’ll help you navigate through the system and provide additional assistance, including:

  • Social support
  • Spiritual guidance
  • Emotional support
  • Practical advice
  • Tips on coping

Call on them. They’re here for you.

Our physicians, nurses and support staff put your health first at Scott & White. We’re here to help you manage your diagnosis of thyroid cancer by compassionately providing you the most current treatment options available.

Your specialists and subspecialists will meet with you to help allay your fears and outline your various treatment options. Our oncology social workers and chaplains are also here to offer guidance and support throughout your treatment process.

To help locate, evaluate and diagnose your thyroid cancer, we have the most advanced diagnostic equipment available. And we have some of the best diagnostic radiologists in the nation to interpret the imaging results. They are a key part of your care team, providing superb imaging and detection.

Our pathology services are outstanding, too. Our board-certified pathologists are skilled at precisely identifying, classifying and staging cancer. They provide crucial information for your individualized treatment plan.

Thyroid Cancer Diagnostic Services

Many cases of thyroid cancer begin with no symptoms. However, if you have symptoms that suggest you may have thyroid cancer, your physician may order one or more of the following tests.

Physical Exam

Your physician will feel your thyroid gland for lumps or nodules. Your physician will also check your neck for swelling or larger growths, such as a goiter. A goiter is an enlarged thyroid gland.

Imaging Studies

Ultrasound

An ultrasound is a machine that uses sound waves to make an image of your thyroid gland and surrounding lymph nodes.

Your surgeon will guide an ultrasound probe over your neck in front of your thyroid gland. The sound waves bounce off your thyroid; a computer rearranges the waves into a picture that can reveal the number and size of the thyroid nodules.

The ultrasound can reveal whether the nodule is solid or filled with fluid. It’s also useful in determining whether any cancerous cells have spread by visualizing the surrounding lymph glands.

“Patients who have a thyroid nodule found on self-exam or by their primary physician is a very common problem. The best initial test for this problem is a biopsy with a very thin needle after anesthetizing the skin with local injection,” says Terry Lairmore, MD, Endocrine Surgeon and Chief of Surgical Oncology. This is called a fine needle aspiration or FNA (see below).

This procedure is performed in the office at the initial visit, either by your surgeon or endocrinologist, who will use the ultrasound scan to localize and successfully sample the nodule.

“The pathologist will come directly to the procedure room to complete the test results and give you a preliminary diagnosis and treatment plan at the same office visit. It is a great benefit to have all of the testing and results performed in the same visit by the treating physician, and have the results interpreted by the surgeon who will perform the procedure if necessary,” says Dr. Lairmore.

Radioiodine Scan

With this test, you’ll swallow or be injected with a harmless amount of radioactive iodine, which is absorbed by your thyroid cells. Several hours later, a special camera will be placed in front of your neck to measure radiation in your thyroid gland.

Areas with higher amounts of radiation contain hot nodules, which are usually not cancerous; areas with less radiation are called cold nodules, which may either be cancerous or not.

This test is not used with patients suspected of having medullary thyroid cancer, as these cells do not take up iodine.

Somatostatin Receptor Scintigraphy (OctreoScan)

Because medullary thyroid cancer doesn’t take up iodine, your physician may order an octreotide scan if he or she suspects you may have MTC.

In this test, radioactive octreotide  (similar to your body’s somatostatin) is injected into a vein; it attaches to tumor cells that have receptors for somatostatin. A special radiation-detecting device is placed in front of your neck to measure radiation in your neck. The octreotide will reveal the presence of any tumor cells.

Additional imaging studies may include:

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Laboratory Tests

Fine Needle Aspiration (Biopsy)

A biopsy is the best way to confirm the presence of thyroid cancer. Your physician will order a biopsy if cancer is suspected based on the results of the diagnostic tests. The type of biopsy used for thyroid cancer is called fine needle aspiration of the thyroid.

A fine needle aspiration of the thyroid is a procedure in which a tiny sample of thyroid tissue and fluid are removed. This procedure is performed in the office at the initial visit, either by your surgeon or endocrinologist, who will use the ultrasound scan to localize and successfully sample the nodule.

“The pathologist will come directly to the procedure room to complete the test results and give you a preliminary diagnosis and treatment plan at the same office visit. It is a great benefit to have all of the testing and results performed in the same visit by the treating physician, and have the results interpreted by the surgeon who will perform the procedure if necessary,” says Dr. Lairmore.

Your surgeon will place a thin, hollow needle directly into the thyroid nodule and remove a few cells from several different places in your neck area. The tissue samples will be sent to the laboratory for evaluation by a pathologist. The results will be sent electronically to your surgeon.

Blood Tests and Tumor Marker Tests

Your physician may order one or more blood tests during and after your treatment. Your physician may also order tumor marker tests. A tumor marker is a substance that may be found in a tumor or released from a tumor into your blood or other body fluids. A high level of a tumor marker may note the presence of a certain type of cancer.

  • Thyroid Hormone Levels. Checks how well your thyroid is functioning, particularly how well it is producing the thyroid hormones triiodothyronine (T3) and thyroxine (T4).
  • TSH. Measures the level of thyroid-stimulating hormone (TSH), produced by the pituitary gland when the thyroid is malfunctioning.
  • Tg and TgAb. After treatment, levels of thyroglobulin (Tg) should be low; if not low, cancer could be present; thyroglobulin antibodies (TgAb) often interfere with the test.
  • Calcitonin. Elevated levels of calcitonin may indicate medullary thyroid cancer (MTC).
  • Carcinoembryonic Antigen (CEA). Elevated levels of CEA may indicate medullary thyroid cancer (MTC).

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