Thyroid cancer diagnosis

Diagnosis

The patient is asked about his medical history (= anamnesis) at the beginning of the contact with the doctor. Here it is of interest whether the thyroid gland has changed in size, whether swallowing difficulties or a clotty feeling in the throat exist. It is important to find out whether there are any thyroid diseases in the family, such as organ enlargement (=stria), hyperthyroidism, hypothyroidism, hypothyroidism or autoimmune diseases that are genetically inherited and lead to the development of thyroid carcinomas (e.g. MEN= multiple endocrine neoplasia).

In addition, the doctor will ask about the patient’s medication and whether he or she has taken contrast media in the last few months. Contrast media containing iodine can lead to hyperthyroidism (hyperthyroidism) and can be problematic for the further diagnostic procedure (see scintigraphic examination). The doctor examines the patient’s thyroid gland when the patient is sitting: the neck is examined and checked for the presence of an enlarged thyroid.

The thyroid gland is palpated in a subsequent step. This is followed by a detailed physical examination of the patient. Patients with abnormal thyroid palpation, i.e. those patients in whom one or more nodes in the thyroid gland are noticeable during the palpation of the neck, are questioned about family history of the disease:As a further, subsequent diagnostic step, a scintigraphic examination of the thyroid gland tissue is performed to assess the activity of the organ and, above all, the functional status of the nodular areas.

Functionally active, hormone producing thyroid cells store iodine. This property is used for scintigraphy: The patient receives iodine via a venous access loaded with the radioactive marker 99mTechnecium-Pertechnat. The iodine accumulates together with the technecium in the thyroid tissue, which enables the examiner to make a quantitative statement on thyroid function.

A so-called cold nodule, as is typically found in a cyst or thyroid cancer, does not store iodine and therefore does not indicate radioactivity. If the cold node is not echo-free in the ultrasound examination, a malignant tumor of the thyroid gland is suspected. In 5-8% of cases, this pattern of findings is a thyroid carcinoma.

In contrast to the carcinoma, the cyst (harmless) is typically echo-free, i.e. it appears completely black in the ultrasound image. The reliable differentiation between a harmless cyst and a malignant tumor of the thyroid gland can only be made after the evaluation of a fine needle puncture of the node. Specimen collection from the local lesion in the thyroid gland (=fine needle biopsy) follows the scintigraphic examination.

It is performed with a thin needle, which is inserted into the suspected area of the thyroid gland under ultrasound guidance. The examiner takes a tissue sample from the cold node, which is examined histologically, i.e. for its cell composition and structures.