Snapshot A 36-year-old woman complains of several weeks of hoarseness and difficulty swallowing. She also feels a sense of fullness in her neck. On physical exam there is a palpable, nontender swelling in the front of her neck that moves with swallowing. There is no cervical lymphadenopathy. Lab studies show decreased TSH. Ultrasound of the neck reveals a 2.5 cm hypoechoic thyroid nodule with calcifications and thyroid scintigraphy shows decreased iodine uptake of the nodule compared to surrounding tissues. Introduction Overview primary malignancy of thyroid gland secondary metasteses can occur from other cancers login to view 1 more bullet Epidemiology Incidence increasing in past 15 years papillary thyroid cancer (most common) has incidence of 15 per 100,000 Demographics papillary more common in women anaplastic more common in elderly Risk factors < 30 or > 70 years of age history of radiation to head/neck family history of login to view 4 more bullets Classification Papillary overview login to view 6 more bullets histology login to view 5 more bullets Follicular carcinoma overview login to view 7 more bullets histology login to view 2 more bullets Medullary overview login to view 10 more bullets histology login to view 1 more bullet Anaplastic overview login to view 3 more bullets Presentation Symptoms dysphagia and hoarseness login to view 2 more bullets Physical exam neck mass or palpable thyroid nodule +/- cervical lymphadenopathy login to view 1 more bullet Imaging Thyroid scintigraphy (radioactive iodine uptake test) indications login to view 1 more bullet findings login to view 9 more bullets Ultrasonography indications login to view 1 more bullet findings login to view 9 more bullets Studies TSH levels decreased TSH more concerning for malignancy login to view 1 more bullet normal/elevated TSH less concerning for malignancy login to view 1 more bullet Serum calcitonin tumor marker for medullary thyroid cancer Fine needle aspiration (FNA) indications login to view 6 more bullets Differential Benign thyroid nodule key distinguishing factors login to view 3 more bullets Treatment Medical iodine radiotherapy login to view 3 more bullets thyroid hormone supplementation login to view 6 more bullets Surgical thyroidectomy login to view 4 more bullets Prognosis Papillary very good prognosis Anaplastic very poor prognosis