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How We Diagnose Thyroid Cancer

  • MRI machine and staff

    Accurately diagnosing thyroid cancer, including the type of thyroid cancer, is a critical step to developing the most effective treatment plan. Our expert endocrinologists, pathologists, cytopathologists, radiologists, and geneticists use advanced techniques to:

    • Evaluate thyroid nodules
    • Distinguish between benign (noncancerous) and malignant (cancerous) disease
    • Confirm a new diagnosis and type of thyroid cancer
    • Assess recurrent disease
    • Provide risk assessment in individuals with a family history of thyroid cancer

    Thyroid nodule evaluation

    Specialists in the Thyroid Nodule Clinic at Brigham and Women's Hospital use the latest diagnostic and imaging technologies to evaluate suspicious thyroid nodules.

    Our endocrinologists have extensive experience examining nodules using ultrasound guidance and testing suspicious nodules through fine needle aspiration (FNA) biopsy. In this office-based procedure, a thin needle is guided by ultrasound to remove cells from the thyroid nodule. These samples are then examined by our pathologists and cytopathologists. The Clinic's registry of thyroid nodule biopsy results allows close monitoring of patient nodules for growth or change.

    Among the largest in the nation, our Thyroid Nodule Clinic is led by Erik Alexander, MD, chief of the Thyroid Section of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's Hospital. Dr. Alexander is a member of a panel of the American Thyroid Association that establishes guidelines for the management of thyroid nodules and thyroid cancer care.

    Radiology (Imaging)

    Imaging by ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) is used to evaluate tumor size and to look for metastasis (spread) of cancer to lymph nodes and other parts of the body. A small amount of radioactive iodine, which is taken up by thyroid cells, may be used to help visualize thyroid nodules and identify metastases during a scan. Imaging is also used to monitor patients for cancer recurrence.

    Molecular and genetic analysis

    We are leaders in the use of advanced molecular and genetic analytical techniques to:

    • Diagnose thyroid cancer.
    • Distinguish between benign and malignant disease.
    • Identify specific tumor characteristics.

    Gene expression classification and gene mutation panels are examples of routine tests used in evaluating patients with thyroid cancer.

    In addition, all patients at Dana-Farber/Brigham and Women's Cancer Center are eligible to participate in the Profile cancer research study, one of the nation's most comprehensive precision cancer medicine initiatives. In this study, tumors are analyzed for the presence of hundreds of mutations and other cancer-related DNA abnormalities. Results from this study have helped to inform treatment in many cases.

    Sometimes, thyroid cancer can be inherited, or be a part of a tumor syndrome. Together with Dana-Farber's Cancer Genetics and Prevention Program and the Pediatric Cancer Genetic Risk Program at Dana-Farber/Boston Children's Hospital, we provide comprehensive risk assessment, genetic testing and counseling, and recommendations for managing risk for individuals with a family history of inherited thyroid cancer syndromes. Our ongoing research is looking at the genetic basis of thyroid cancer with a focus on inherited thyroid cancer.

    Staging

    The staging of thyroid cancer is the process of finding out if, and how far, the cancer has spread. In papillary and follicular cancers, patients younger than age 45 are generally classified as having Stage I or II thyroid cancer. Anaplastic thyroid cancers are always considered Stage IV. Medullary thyroid cancer spans Stage I, Stage II, Stage III, Stage IVA, Stage IVB, and Stage IVC.

    Determining the cancer's stage (I-IV) is based on several factors, including:

    • Patient age and type of thyroid cancer.
    • Size of the primary tumor.
    • Extent of spread to regional (nearby) lymph nodes.
    • Metastasis (spread) of thyroid cancer to other organs.