THYROID CANCER DIAGNOSIS

Physicians use several tests to confirm the suspicion of thyroid cancer, to identify the size and location of the lump and to determine whether the lump is non-cancerous (benign) or cancerous (malignant). Blood tests such as the thyroid stimulating hormone (TSH) test check thyroid function. These are drawn by a technician with a needle and takes a few minutes. It take several days to be interpreted by a pathologist. Calcitonin is produced by the C cells (parafollicular cells) of the thyroid gland when the parafollicular cells of the thyroid become cancerous. Blood calcitonin levels are used to confirm the diagnosis of medullary thyroid cancer if it is suspected.

Computed tomography scan (CT scan) or an ultrasonography (ultrasound scan) are imaging tests used to produce a picture of the thyroid and usually last less than one hour. A radiologist usually interprets the results within 24 hours. In ultrasonography, high-frequency sound waves are bounced off the thyroid. The pattern of echoes that is produced by these waves is converted into a computerized image on a television screen. This test can determine whether the lumps found in the thyroid are benign fluid-filled cysts or solid malignant tumors.

A radioactive scan may take several hours and can be used to identify any abnormal areas in the thyroid by giving the patient a very small amount of radioactive iodine, which can either be swallowed or injected into the thyroid. Since the thyroid is the only gland in the body that absorbs iodine, the radioactive iodine accumulates there. An x-ray image can then be taken or an instrument called a "scanner" can be used to identify areas in the thyroid that do not absorb iodine normally. These abnormal spots are called "cold spots" and further tests are performed to check whether the cold spots are benign or malignant tumors. If a significant amount of radioactive iodine is concentrated in the nodule, then it is termed "hot" and is usually benign. Again a radiologist interprets the results within a day.

The most accurate diagnostic tool for thyroid cancer is a biopsy. In this process a sample of thyroid tissue is withdrawn and examined under a microscope by a pathologist. This usually takes a day or so. The tissue samples can be obtained either by drawing out a sample of tissue through a needle (needle biopsy) or by surgical removal of the nodule (surgical biopsy). A needle biopsy takes a few minutes and can be done by any trained physician, usually a radiologist. The surgical biopsy is done by a surgeon under general anesthesia with the help of an anesthesiologist and will take a few hours. If thyroid cancer is diagnosed, further tests may be done to learn about the stage of the disease and help doctors plan appropriate treatment.