You may be reading this because you’re worried about getting thyroid cancer. Maybe you’re waiting for test results. Or, perhaps you or someone you care about just learned they have thyroid cancer.
This guide will help you understand how thyroid cancer is diagnosed and what your diagnosis means. Learning as much as you can may help you feel ready to talk with doctors about your care.
If your doctor thinks you have thyroid cancer, an ultrasound will tell if you need a biopsy or more imaging tests. A thyroid cancer biopsy is a procedure to remove cells from a growth in your neck to test for cancer.
A thyroid cancer diagnosis most often will describe where the cancer started, its type, and if it has spread. We use this information to create a care plan just for you.
Some people notice a lump or swelling in the front of their neck, called a thyroid nodule. Thyroid nodules are very common, but it’s rare for those nodules to be thyroid cancer.
Doctors use a few tests and procedures to diagnose thyroid cancer. Your doctor will learn if your thyroid nodule is one of the rare ones that has cancer. If it’s cancer, they’ll diagnose the thyroid cancer’s type and stage.
Medical oncologist Dr. Devika Rao shares tips on what to expect during your first visit at MSK, and how to get ready.
We want to ensure your first visit is as productive and supportive as possible. Here are some tips on how you can best prepare.
You also may have other imaging tests, such as a CT, MRI, or PET scan. Based on all imaging results, your doctor may order a biopsy.
MSK’s Thyroid Nodule Assessment Program offers a fast, precise diagnosis if you have a lump (growth) in your thyroid. You do not need a referral from your doctor, or tests before your visit. For an appointment, call 800-525-2225, Monday through Friday, to 5:30 p.m.
During a thyroid biopsy, your doctor removes a small sample of cells or tissue from the thyroid nodule. A pathologist is a doctor who uses a microscope to diagnose disease. They’ll learn if the cells in the sample have cancer.
A biopsy provides information about the type of cancer cells. This helps doctors choose which treatment is best for you, based on the type of thyroid cancer.
A fine needle aspiration (FNA) procedure of the thyroid uses a thin needle to take out cells from a thyroid nodule.
It can be done in your doctor’s office. It also can be done by a radiologist, a doctor with special training in using imaging to diagnose and treat disease. Your radiologist uses ultrasound to help guide the needle into the thyroid nodule.
A core needle biopsy for thyroid nodules is done when thyroid cancer is more advanced. The cancer has metastasized (spread) outside the thyroid gland. A core biopsy uses a larger needle.
Molecular testing is another tool for learning more about a thyroid nodule.
In a very few cases, a biopsy of a large thyroid nodule takes a sample that misses an area with cancer.
DNA tests give more information about the nodule. They help your care team decide whether active surveillance or surgery is best for you. Surveillance means monitoring or watching. We'll watch for any changes in the nodules.
Molecular tests can predict the chance a thyroid nodule has cancer. They also find genetic changes linked to thyroid cancers with a higher chance of spreading or recurring (coming back).
We use the tissue from the fine needle aspiration biopsy to test the thyroid nodule’s DNA. This type of molecular test looks for certain DNA changes (mutations or variants) linked to thyroid cancer.
A gene classifier is a type of molecular test. It measures changes in genes linked to thyroid cancer. The test then scores how likely it is that the thyroid nodule is malignant (cancer) or benign (not cancer).
Blood tests can help tell if the thyroid gland is working well by measuring thyroid-stimulating hormone (TSH or thyrotropin) levels.
If your TSH level is low, you may have a TSH test for follicular thyroid cancer. The test also may measure your level of T3 and T4 hormones, which are made by the thyroid.
It’s also important to test blood for your level of calcitonin. C cells in your thyroid make calcitonin, a hormone that helps your body control how it uses calcium. C cells can turn into medullary thyroid cancer (MTC).
Your doctor may recommend a blood test:
MSK’s hereditary cancer and genetics program offers information about how to get tested for MTC. We recommend genetic testing for children, brothers, and sisters of people who have medullary thyroid cancer.
Your doctor may suggest genetic counseling and testing if your parent, brother, or sister has medullary thyroid carcinoma.
Genetic testing of DNA tells us if you were born with gene changes (mutations or variants). These genetic changes raise your chance of getting thyroid and sometimes other cancers.
We’ll ask for your written permission to do this medical test. Before testing, we’ll review your personal and family cancer history to help decide which test is right for you. We’ll explain the test and what the results could mean.
Thyroid cancer genetic testing involves taking a sample of blood or saliva. You can give a blood sample at an MSK location near you. Or, we’ll mail a saliva kit to your home.
The results come back from the lab in a few weeks. We’ll go over them with you. If the test shows a gene change that raises your cancer risk, we’ll help you understand what that means. We’ll talk about ways to lower your risk.
We have a video that explains genetic testing.
Diagnosis tests may show you have thyroid cancer, and if the cancer is low risk or high risk. The tests tell us how likely it is that the cancer will spread past the thyroid gland. Your treatment options are based on the thyroid cancer’s risk level.
What is low-risk thyroid cancer?
Thyroid cancer is called low risk if it’s small and only in the thyroid gland. Most people who have low-risk thyroid cancer are aged 20 to 45.
What is high-risk thyroid cancer?
Thyroid cancer is called high risk if it’s spread past the thyroid gland or grows fast. Most people who have high-risk thyroid cancer are over age 45.
Newly diagnosed? Hear advice from our patients.
Michael:
You have a diagnosis of cancer, and there's all this fear and there's apprehension and you're nervous and you're scared. You've got surgery in front of you. You've got quality of life issues ahead of you. What I wish I had known was that you can come out the other side of this journey.
Lorena:
When I received the news that I had cancer, it was devastating and I was lost, completely lost.
Ming:
You are meeting with a lot of different people, so what I would really recommend to patients is just do your best to take notes.
Michael:
Come to the appointment prepared. Come with questions.
Norma:
I had questions about my recovery. I had questions about the possibility of chemo. I was placed on a clinical trial, and I had questions about that.
Michael:
Prior to coming to MSK, my wife and I had been to a variety of different doctors, and we got a lot of different answers and no clear direction. It was the first time that a definitive plan was put in place where I actually had a recommendation of which way to go.
Ming:
My care team consisted of doctors, social workers, nurses.
Michael:
It's not just one doctor you're dealing with. You're dealing with all of MSK and their entire team approach to your care.
Lorena:
The way they greet me, it was just overwhelming. I was so happy. It was 100% personalized for me.
Norma:
I was told to expect patient-centered care and I kind of felt that from the beginning, from that first day that I walked in.
Ming:
There were even people there just to hang out with me and to kill time. If you need something, ask. And even if it's something small like, “Nothing tastes good,” or “Everything tastes awful and I can't eat any of this,” it's important to tell someone and they can help you address your needs as a patient
Lorena:
One of the programs that I found helpful was Integrated Medicine. For example, acupuncture. It helped me to calm down; and then after the treatment, it managed the pain.
Norma:
I immediately used the nutrition program because it was amazing. I used their PT program. I used their Visible Ink program, which is wonderful and it gives you tremendous emotional support.
Lorena:
Another thing that is very helpful is the MSK Patient Portal. You can set up appointments. You can request prescriptions. You can also use the portal for a telemedicine visit. On the days that you don't have any energy, telemedicine is there for you. There is no difference at all between being seen in person or telemedicine.
Norma:
I never felt that I couldn't call someone, even if it was the doctor's nurse, and just talk.
Ming:
The silver lining from being diagnosed with cancer is I taught myself how to be positive.
Lorena:
This experience taught me to live in the moment, and you learn how to live life in a better way.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
Learning you have thyroid cancer can be overwhelming. You’ll hear many medical terms you've never heard before. We’re here to help you understand what they mean and why they matter.
The information in your diagnosis describes important details about the type of thyroid cancer you have. Your doctors use that information to create the best plan of care for you.
Chatbots can be a good way for you to learn more about what’s going on with your health. They can even give accurate information about cancer. But there also are many problems with chatbots. MSK experts share tips on how to use these AI tools, and why your care team has the best information for you.
About half of papillary thyroid cancers have a mutation in the BRAF gene. Less often, papillary thyroid cancers have changes in:
Follicular thyroid cancer most often has a change in RAS genes.
Anaplastic thyroid cancers have a change in:
About half of the people who do not have an inherited form of medullary thyroid cancer have a mutated RET gene. About 1 out of every 4 people who have MTC inherit the disease because of a mutated RET gene.
MSK's Rapid Diagnosis service can offer fast access to cancer care. MSK’s experts provide rapid biopsy and diagnosis of samples from solid tumors and lymphomas.
When you learn you have thyroid cancer, you’ll have many questions for your cancer doctor at your first visit. Talking about treatment options with your doctor can help you feel better prepared to make decisions about your care.
There are many types of thyroid cancer. MSK is experienced in treating them all, from the most common, like papillary, to the most rare, like anaplastic carcinoma. This information describes each type of thyroid cancer and explains how we classify (sort) them.
Whether a tumor spreads, and how fast it spreads, depends on the type of thyroid cancer. Thyroid cancer is either differentiated or undifferentiated, based on how the cells look under a microscope compared to normal cells.
Differentiated thyroid cancers include:
Differentiated thyroid cancers look like normal thyroid cells under a microscope. Differentiated thyroid cancers can grow very slowly and may stay in the thyroid.
Undifferentiated thyroid cancers include:
Undifferentiated thyroid cancers look abnormal (not normal) under a microscope. Undifferentiated thyroid cancers can spread faster than differentiated thyroid cancer.
Papillary thyroid cancer, the most common type of thyroid cancer, is very treatable and curable. More women than men get papillary thyroid cancer, and most people are in their 30s and 40s.
Papillary thyroid cancer grows slowly, often starts in 1 lobe of the thyroid, and can spread to nearby lymph nodes.
Here are symptoms of papillary thyroid cancer.
Surgery is the most common papillary thyroid cancer treatment at MSK. You may also get radioactive iodine to lower the chances cancer will come back. We may suggest active surveillance (monitoring or watching) if the papillary thyroid tumor is low risk.
Follicular thyroid cancer is less common than papillary thyroid cancer. Out of every 100 people who have thyroid cancer, about 15 have follicular thyroid cancer.
Follicular thyroid cancer can grow slowly and spread to the bones and organs, such as the lungs. At MSK, follicular thyroid cancer often can be cured with the right treatment.
If follicular thyroid cancer recurs (comes back), your doctor may recommend:
Here are common symptoms of follicular thyroid cancer.
Hurthle (HEERT-luh) cell carcinoma, also called oncocytic thyroid cancer, is similar to follicular cancer and can spread through the bloodstream. It can be hard to diagnose and treat.
To diagnose Hurthle cell carcinoma, your surgeon often must remove half or all of the thyroid.
The best way to treat Hurthle cell carcinoma is surgery at MSK to remove the thyroid.
Learn more about the common symptoms of Hurtle cell carcinoma.
Medullary thyroid carcinoma (MTC) is rare. Out of every 100 people with thyroid cancer, only 4 to 10 of them have MTC. Most people with MTC are older adults.
MTC affects 1 thyroid lobe and starts in C cells that make the hormone calcitonin. MCT can spread to the liver and lungs.
About 3 out of every 4 people with MTC do not have a family history of the disease. About 1 out of every 4 of people with MTC have a RET gene mutation.
Treatment for medullary thyroid cancer at MSK includes:
Here are common MTC symptoms.
Some people inherit familial medullary thyroid carcinoma (FMTC), a form of MTC. FMTC starts during childhood or early adulthood and is in a few parts of the thyroid gland.
If you have a mutation in the RET gene, this means you have multiple endocrine neoplasia type 2 (MEN 2). Almost everyone who has MEN2 gets medullary thyroid cancer when they’re a child.
One way to prevent getting familial medullary thyroid carcinoma is surgery at MSK to remove the thyroid before FMTC starts.
Learn more about common symptoms of FMTC.
Anaplastic carcinoma is rare, affecting only 2 out of every 100 people with thyroid cancer. It often starts from papillary thyroid cancer or follicular thyroid cancer.
Anaplastic carcinoma spreads fast through the neck and to other areas, making it harder to treat and cure.
Anaplastic carcinoma treatment at MSK may include surgery or external radiation. You may also get chemotherapy with radiation therapy (chemoradiation):
Here are common symptoms of anaplastic carcinoma.
Many people with cancer prefer to get treatment closer to home. MSK provides excellent cancer care on Long Island and in locations in Westchester County, New Jersey, and New York City. You can meet with your surgeon and have chemotherapy, radiation therapy, and genetic testing.
A cancer stage tells us how advanced the cancer is. It describes traits such as the tumor’s size, location, and whether it has spread.
There are 4 stages of thyroid cancer, from 1 to 4 (I to IV). The lower the number, the less the cancer has spread. Your doctor may add a letter (A, B, or C) to these stages to give even more information.
Staging helps your doctor choose the best treatment options for you. The stage also helps them predict the outcome (result) of your treatment. Based on the stage, you may also be able to join a clinical trial.
N0 means cancer is not in lymph nodes.
N1, N2, or N3 means it’s spread to nodes.
M0 means cancer has not spread.
M1 means it’s spread to distant organs, muscles, or bones.
There is only a stage 1 and a stage 2 for people who are younger than 55.
Papillary thyroid cancer is stage 1 if it has not spread to distant parts of the body. Papillary thyroid cancer is stage 2 if it has distant spread.
Stage 1
The tumor is any size. It may have spread to nearby lymph nodes. It has not spread to distant areas.
In the TNM staging system: Any T, any N, M0.
Stage 2
The tumor is any size. It may have spread to nearby lymph nodes. It has spread to distant areas, such as the lungs or bones.
In the TNM staging system: Any T, any N, M1.
The tumor is only in the thyroid. It’s not bigger than 4 centimeters. It has not spread to nearby lymph nodes.
In the TNM staging system: T1, T2, N0, M0.
The tumor is only in the thyroid.
It’s not bigger than 4 centimeters. It has spread to nearby lymph nodes.
Or, the tumor is bigger than 4 centimeters and may have spread to nearby lymph nodes.
Or, the tumor is in the neck muscles and may have spread to nearby lymph nodes.
In the TNM staging system: T1, T2, T3, N, N1, M0.
The tumor is any size. It’s spread past the thyroid to nearby neck tissues. It can be in the larynx (voice box), trachea (windpipe), or esophagus (food tube). Cancer may be in nearby lymph nodes.
In the TNM staging system: T4a, any N, M0.
There is a stage 4a and a stage 4b.
Stage 4a
The tumor is any size. It grew past the thyroid, to the tissue or the bones of the spine, or into nearby large blood vessels. Cancer may have spread to nearby lymph nodes. It has not spread to distant areas.
In the TNM staging system: T4b, any N, M0.
Stage 4b
The tumor is any size. It may have grown past the thyroid. It may have spread to nearby lymph nodes. The cancer has spread to other areas, such as the bones or lungs.
In the TNM staging system: Any T, any N, M1.
The tumor is only in the thyroid gland. It can be any size. Cancer has not spread to lymph nodes or to other areas.In the TNM staging system: T1 to T3a, N0, M0.
There are 3 types of stage 4b.
The tumor can be any size. It has spread to nearby lymph nodes.
Or, the tumor has spread past the thyroid to nearby neck tissues. Cancer may be in nearby lymph nodes.
Or, the tumor has spread past the thyroid to nearby areas. It can be in the larynx (voice box), trachea (windpipe), or into nearby large blood vessels. Cancer may be in nearby lymph nodes.
In the TNM staging system: T4b, any N, M0.
The tumor can be any size. It has spread past the thyroid and neck to other parts, such as the bones or lung. It may have spread to distant lymph nodes.
In the TNM staging system: Any T, any N, M1.
The tumor is only in the thyroid. It’s 2 centimeters or smaller. It has not spread to nearby lymph nodes.
In the TNM staging system: T1, N0, M0.
The tumor is 2 centimeters or larger and is only in the thyroid. It has not spread to nearby lymph nodes or other parts.
Or, the tumor is any size, It has spread to nearby neck muscles. Cancer has not spread to nearby lymph nodes.
In the TNM staging system: T2, T3, N0, M0.
The tumor is any size. Cancer has spread to nearby neck muscles and to lymph nodes in the neck.
In the TNM staging system: T1, T2, T3, N1a, M0.
There is a stage 4a, 4b, and 4c. For all stage 4 cancers, the tumor can be any size.
Stage 4a
The tumor may have spread to lymph nodes but not to distant parts.
Or, the tumor has spread to lymph nodes in the neck. It may have spread to nearby neck muscles.
Or, the tumor has spread to a few areas, such as the trachea, esophagus, larynx, or tissue under the skin. It may have spread to nearby lymph nodes.
In the TNM staging system: T4a, N0 to N1a, M0 or T1, T2, T3, N1b, M0.
Stage 4b
Cancer may have spread to lymph nodes. It has not spread to other parts. The tumor has spread to the spine or to tissue in front of the spine. Or, it spread to nearby large blood vessels.
In the TNM staging system: T4b, any N, M0.
Stage 4c
Cancer has spread to other parts of the body, such as the lung, liver, bone, or brain. It may be in lymph nodes.
In the TNM staging system: Any T, any N, M1.
