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Primary Care Otolaryngology
Chapter 15
Thyroid Cancer
Thyroid Nodules and Cancer
Thyroid cancer and the management of thyroid masses can be a confusing
topic of discussion.
Thyroid nodules
are singular or multiple, often encap-
sulated, growths found on the thyroid gland. They are most frequently
benign and so common, particularly with advancing age, as to preclude
biopsy and removal in every patient who presents with nodules. However,
otolaryngologists often recommend and perform removal of nodules that
have a reasonable risk of being cancerous, as determined by multiple fac-
tors that include those discussed below.
Risk factors for malignant thyroid nodules are based on gender, age, early
radiation exposure, and family history of thyroid cancer. While thyroid
nodules are much more common in women than in men, a nodule in a
male has a higher risk of being cancerous than a nodule in a female. Older
people also develop more benign nodules than younger people (i.e., a
nodule in a person younger than 40 years old has a higher chance of being
cancerous than a nodule in a person over 40).
In addition, larger nodules and nodules that
demonstrate growth are more commonly
malignant.
The standard accepted and effective method for
determination of the contents of a thyroid mass
or nodules is fine-needle aspiration biopsy
(FNAB). This may be performed with or with-
out ultrasound guidance, depending on the size
and location of the lesion. While cytopatho-
logic interpretation has improved, a clear diag-
nosis for malignancy is not always achieved.
Reports, such as “indeterminant,” “suspicious,”
or “noninformative,” are frequently tendered to
the surgeon or endocrinologist, making the
Figure 15.1.
Large neck mass eccentrically
located in the right neck.