Papillary Thyroid Carcinoma Clinical Presentation

Updated: Jun 14, 2022
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neerav Goyal, MD, MPH, FACS  more...
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The most common presentation of thyroid cancer is an asymptomatic thyroid mass or a nodule that can be felt in the neck. For any patient with a thyroid lump that has developed recently, record a thorough medical history to identify any risk factors or symptoms. In particular, obtain a history regarding every prior exposure to ionizing radiation and the lifetime duration of the radiation exposure. Consider a family history of thyroid cancer.

Some patients with thyroid cancer have persistent cough, difficulty breathing, or difficulty swallowing. Pain is seldom an early warning sign of thyroid cancer. Other symptoms (eg, pain, stridor, vocal cord paralysis, hemoptysis, rapid enlargement) are rare, and can be caused by less serious problems.

At the time of diagnosis, 10-15% of patients with papillary thyroid carcinoma have distant metastases to the bones and lungs. Typically, these patients are initially evaluated for pulmonary or osteoarticular manifestations (eg, pathologic fracture, spontaneous fracture).


Physical Examination

The clinician should 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 palpable nodule, usually solitary, in the thyroid area that has the following characteristics:

  • Painless
  • Hard consistency
  • Average size of less than 5 cm
  • Ill-defined borders
  • Fixed in respect to surrounding tissues
  • Moves with the trachea during swallowing

If cervical lymphadenopathy is present, it may be palpable on either the ipsilateral or contralateral side.

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