Localized Lesion Symptoms

1. Often none. Lesion may be found by physician during routine examination.

2. Many patients will have a history of pre-existing goiter often dating back many years. The patient may notice a change in the character of such a goiter (e.g., increase in size, hardness, etc.) as first symptom.

3. Patient may have suddenly become aware of a lump in the neck without any history of pre-existing goiter, or a friend or member of the family may note a fullness and call it to the patient's attention.

Signs

1. May be a solitary nodule of minute size anywhere in the thyroid; more commonly 2 to 4 cm. in size and well demarcated from surrounding normal tissue.

2. May be an area arising from within an enlarged and/or nodular goiter. It may be set apart from surrounding nodular tissue by virtue of its firmness or hardness and known recent increase in size, but this is often not the case. Many, in fact, are diagnosed histologically as a result of the surgical removal of a thyroid nodule clinically indistinguishable from a benign colloid or nodular goiter.

Advanced Lesion Symptoms

1. Locally invasive and infiltrative disease producing gross enlargement and induration of the thyroid gland with fixation to surrounding structure. It is important to bear in mind that thyroiditis in its various forms may simulate cancer very closely.

2. Obstructive phenomena due primarily to local progression of the disease involving the trachea and larynx (stridor, dyspnea), esophagus (dysphagia), and recurrent laryngeal nerve (hoarseness).

3. Adenopathy. A relatively frequent occurrence, unilateral or bilateral. Obvious metastatic adenopathy may occur before there is any suspicion of thyroid cancer, and even then the primary lesion may be very difficult to demonstrate. This is particularly true in the case of papillary thyroid cancer-the so-called "lateral aberrant thyroid."

4. Distant metastases. By far the commonest site of distant metastases are the bones, and the first clue to the existence of the disease may be symptoms referrable to the skeletal system (e.g., pathologic fracture). The lungs and other viscera may be involved too.

5. A relatively distinctive fulminating clinical picture is presented by the giant cell or spindle cell carcinoma.

(a) Abrupt onset and rapid progression of a thyroid tumor, often producing a "bull neck."

(b) Acute pain, tenderness, and even warmth over the rumor.

(c) Death rapid due to local obstructive effects rather than to metastatic spread.