Thyroid Cancer Differential Diagnosis Table

There are small glands at the base of the neck that produce the thyroid hormone called thyroxine. The tumor in the gland or the abnormal secretion of thyroid hormones indicates thyroid cancer, which usually appears in the late 30s to 40s and is 2 to 3 times more common in women than in men. It is the rarest type of cancer to affect the thyroid.

A lump in the neck, change in voice, difficulty swallowing, swollen lymph nodes in the neck, and pain in the neck and throat are the most common symptoms of thyroid cancer. Usually, thyroid cancer, like many other cancers, does not cause any symptoms or signs in its early stages, but it does show up later.

There are four stages of thyroid cancer. Each stage has a different symptom and sign. Stage 1 thyroid cancer has a lump (nodule) in the thyroid gland less than 2 cm, while in stage 2 it grows but remains less than 4 cm. In stage 3, the tumor becomes larger than 4 cm but remains within the borders of the thyroid and does not cross, while in stage 4 the tumor exceeds the borders of the thyroid and appears as a large lump on the neck.

Thyroid cancer can be caused by a long-standing goiter or thyroid inflammation, but not by an overactive or underactive thyroid. Usually, family genetics play an important role in the development of cancer, including thyroid cancer.

Thyroid Cancer Differential Diagnosis Table:

The thyroid gland, a part of the endocrine system, is situated in the frontal part of the throat, where it is actively involved in managing bodily processes like growth and metabolism. Roughly, every 1 in 20 people around the world faces some form of thyroid dysfunction, including cancer.
Thyroid cancer, the most common endocrine cancer, is the malignant transformation of the cells of the thyroid parenchyma. Although it’s rare, it is treatable, making the survival rate high. In the beginning, the only presenting complaint is the neck swelling. In advanced cases, other symptoms arise like pressure and a choking sensation in the neck, hoarseness of voice, swollen lymph nodes, difficulty swallowing, fever, weight loss, and anorexia.

How To Distinguish Thyroid Cancer from Other Diseases

Distinguish Goiter from Thyroid Cancer – Diagnosis

Goiter is a term used to describe a situation of diffuse or nodular enlargement of the thyroid gland. The enlargement could be due to an increased or decreased thyroid production.

• During swallowing, the benignly enlarged thyroid gland moves upward; if it doesn’t, it is suggestive of thyroid cancer.
• Thyroid cancers, along with thyroid enlargement, cause regional lymphadenopathy, unlike goiter.

“During clinical examination, malignant transformations feel hard and rough to palpation; meanwhile, goiter is softer.”

Distinguish Benign Thyroid Nodules from Thyroid Cancer – Diagnosis

Benign thyroid nodules refer to the lumps of unusual growth in the thyroid gland that are almost always not cancerous. Thyroid nodules can be hot (produces too much thyroid hormone) or cold (produces little thyroid hormone). Hot nodules are almost always benign, while cold nodules can be cancerous.

• Nodules are smaller, and they are not commonly associated with symptoms like hoarseness of voice and difficulty in swallowing, a very typical presentation of thyroid cancer.
• Moreover, unlike thyroid cancer, they do not produce regional lymphadenopathy.

“Biopsy differentiates a benign nodule from a cancerous one. Malignant nodules feel hard, firm, and fixed on palpation. While the benign one feels soft and moveable.”

Distinguish Hypothyroidism from Thyroid Cancer – Diagnosis

Hypothyroidism is a condition of underproduction and release of thyroid hormone by the thyroid gland.

• Hypothyroidism slows down the metabolism, so it is often accompanied by weight gain. Whereas, the opposite can be seen in the case of thyroid cancer.
• Neck lumps and swelling commonly visible in the case of thyroid cancer are not present in hypothyroidism.
• Most of the patients with thyroid cancer often suffer from insomnia and sleep disturbances, while the hypothyroidism patients sleep more than normal, sometimes 12 to 14 hours per day.

Distinguish Hyperthyroidism from Thyroid Cancer – Diagnosis

Hyperthyroidism is the overproduction and release of thyroid hormone by the thyroid gland.

• A very common symptom of hyperthyroidism is exophthalmos, also known as protruding or bulging eyes, which cannot be seen in thyroid cancer.
• Moreover, hoarseness of voice and difficulty swallowing, typical of thyroid cancer, are not present in hyperthyroidism.
• Thyroid cancers are frequently accompanied by regional lymphadenopathy, unusual to find in hyperthyroidism.
• Hyperthyroidism also produces cardiovascular symptoms like palpitations, not found in thyroid cancer.

Distinguish Hashimoto’s Thyroiditis from Thyroid Cancer – Diagnosis

Hashimoto’s thyroiditis is an autoimmune disorder that causes a breakdown of thyroid hormone-producing cells and results in hypothyroidism.

• Hashimoto’s thyroiditis, being an autoimmune disease, causes joint pain and muscle ache. That is rare with thyroid cancer.
• Moreover, the common associated lymphadenopathy with thyroid cancer is not seen with Hashimoto’s thyroiditis.

Distinguish Graves’ Disease from Thyroid Cancer – Diagnosis

Graves’ disease is an autoimmune disorder that results in an overproduction of thyroid hormone.

• Typically, Grave’s disease causes protrusion of the eyeballs, which ultimately causes ulceration of the cornea and vision defects. These findings are not seen in thyroid cancers.
• People with Graves’ disease are heat-sensitive, usually present with sweaty and warm palms. This is a rare finding among thyroid cancer patients.
• A very typical manifestation of Graves’ disease is pretibial myxedema, which affects the legs and looks like swollen, scaly, and dry lesions on the skin. It is not associated with thyroid cancer.

“On clinical examination, signs like Von Graefe’s, Joffroy’s, Stellwag, Dalrymple’s, and Möbius in eyes confirm the presence of Graves’ disease.”

Distinguish Thyroiditis from Thyroid Cancer – Diagnosis

Thyroiditis is a group of conditions involving inflammation of the thyroid gland by infection, iatrogenic processes, drugs, autoimmune conditions, and fibrosis.

• Acute and Subacute thyroiditis are usually accompanied by typical infection symptoms like fever, redness, and pain. However, thyroid cancer is painless and doesn’t produce redness.
• Drug-induced thyroiditis causes hypothyroidism, producing weight gain; cancers in general are linked to weight loss.

“On clinical examination, unlike thyroid cancer, acute thyroiditis is tender to palpation.”

Distinguish Thyroid Cysts from Thyroid Cancer – Diagnosis

A thyroid cyst represents those thyroid nodules that are filled only with fluid and are benign in nature.

• They are the same as the thyroid nodules; when smaller, they are not commonly associated with symptoms like hoarseness of voice and difficulty in swallowing, a very typical presentation of thyroid cancer.
• Also, they do not produce regional lymphadenopathy like thyroid cancer.

Distinguish Euthyroid Sick Syndrome from Thyroid Cancer – Diagnosis

Euthyroid sick syndrome is a condition presenting in critically ill patients who have no thyroid illness but show low levels of thyroid hormones.

• Euthyroid sick syndrome presents no specific thyroid disease-related symptoms. For instance, thyroid enlargement and neck lump typically present in thyroid cancer are not seen in euthyroid sick syndrome.
• Since there is no neck lump, the associated issues with a neck lump like hoarseness and dysphagia are usually not present in euthyroid sick syndrome.

Common Red Flags With Thyroid Cancer

Thyroid lumps and enlargement are common and can occur with any thyroid condition. The chances of them being malignant are less, but never zero. Also, there is currently no screening test for thyroid cancer; any swelling and lump in the neck should be regarded seriously.
The symptoms of a malignant lump are similar to those of a benign one. As a result, the chances of misdiagnosis are greater. The only distinguishing thing is a biopsy.

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