Follicular Thyroid Carcinoma Clinical Presentation

Updated: Jun 14, 2022
  • Author: Luigi Santacroce, MD; Chief Editor: Neerav Goyal, MD, MPH, FACS  more...
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Many cases of follicular thyroid cancer (FTC) are subclinical. The most common presentation of thyroid cancer is as an asymptomatic thyroid mass or nodule that can be felt in the neck. Pain seldom is an early warning sign of thyroid cancer.

Record a thorough medical history to identify any risk factors or symptoms. For any patient with a lump in the thyroid that has appeared recently, focus on any prior exposure to ionizing radiation, as well as the cumulative lifetime exposure; 1 Gy of radiation to the thyroid has an estimated attributable risk of 88%. For children, doses as low as 50-100 mGy are associated with an increased risk of thyroid cancer, with a linear dose response up to 10-20 Gy. This risk persists for about 4 years from exposure. [19]  Note that of the thyroid cancers, papillary thyroid carcinoma has the highest risk with ionizing radiation.

Also consider any family history of thyroid cancer. [20]

Some patients have persistent cough, difficulty breathing, or difficulty swallowing. Other signs and symptoms (eg, pain, stridor, vocal cord paralysis, hemoptysis, rapid enlargement) are rare. Those can be caused by less serious problems.

At diagnosis, 10-15% of patients have distant metastases to bone and lung and initially are evaluated for pulmonary or osteoarticular symptoms (eg, pathologic fracture, spontaneous fracture).


Physical Examination

Palpate the patient's neck to evaluate the size and firmness of the thyroid and to check for any thyroid nodules. The principal sign of thyroid carcinoma is a firm and nontender nodule in the thyroid area.

Some patients have a tight or full feeling in the neck, hoarseness, or signs of tracheal or esophageal compression.

Palpable thyroid nodules are usually solitary, with a hard consistency, an average size of less than 5 cm, and ill-defined borders. This nodule is fixed in respect to surrounding tissues and moves with the trachea at swallowing.

Usually, signs of hyperthyroidism or hypothyroidism are not observed.