5 Thyroid Cancer Symptoms a Top Surgeon Says Are Easy to Miss—But Crucial to Catch
Plus see the one question you should ask your endocrinologist
While any cancer diagnosis is frightening, thyroid cancer has a remarkably high cure rate when caught early. Here, a top surgeon shares everything you need to know about thyroid cancer symptoms—including the surprising reason women are diagnosed more often than men—the newest treatments and the one question you should ask your doctor to ensure the best possible care.
What does the thyroid do? The many roles it plays
Tiny-but-mighty is an understatement when it comes to describing this multitasking gland. “The thyroid is a small, butterfly-shaped organ in the front of your neck, and its job is to control how the body uses energy,” explains Julie Ann Sosa, MD, MA, FACS, an endocrine surgeon specializing in thyroid cancer and Chair of the University of California, San Francisco (UCSF) Department of Surgery.
What specifically is the thyroid responsible for? “It produces hormones—primarily T3 and T4—that regulate your metabolism, essentially controlling how fast or slow your body’s cells work,” she continues. “These thyroid hormones affect many systems in the body, from heart rate and body temperature to digestion, brain function, mood and energy levels.”
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Simply put, the thyroid is punching above its weight. “It’s a very powerful organ, and you can’t live without it,” Dr. Sosa emphasizes.
What you need to know about thyroid nodules and cancer rates
You may be surprised to learn that thyroid nodules—small lumps in the thyroid—are extremely common, says Dr. Sosa. “As many as half of Americans may have at least one thyroid nodule. The reassuring news is that the vast majority of these nodules are benign. In fact, about 95 to 98 percent are not cancerous.”
Thyroid cancer itself, however, is not rare. Over roughly 30 years (about 1985–2015), the incidence of thyroid cancer increased by more than 300 percent, making it one of the fastest-rising cancers worldwide, she notes. “We now believe much of that increase was due to overdiagnosis.
Indeed, as medical imaging became more common—ultrasounds, CT scans, MRIs—doctors began detecting very small thyroid nodules that might never have caused harm, Dr. Sosa explains. “Many of these tiny cancers were treated aggressively, which we now recognize was often unnecessary. The risks of treating really tiny cancers probably outweigh the benefits of treating them. Today, updated guidelines are helping doctors better distinguish which cancers truly require treatment.”
5 subtle thyroid cancer symptoms to watch for
Most people with thyroid cancer actually don’t have any symptoms and have normal thyroid function. “Recent data suggest that about 70 percent of patients are asymptomatic,” Dr. Sosa confirms. When symptoms do occur, they tend to be very subtle. Here, she highlights a few of the nuanced signs:
- A painless lump in the front of the neck. Sometimes it’s discovered incidentally on an imaging study done for another reason, like a carotid ultrasound, she notes. “Other times, a family member across the dinner table will notice—someone might say, ‘What’s that on your neck?’ during a holiday gathering.”
- Feeling a lump or tightness in the throat. This is known as a globus sensation. People may also experience mild difficulty swallowing
- Changes in the voice, such as hoarseness or a rasp
- A persistent cough that isn’t due to a cold.
- Occasional difficulty breathing or a sensation of pressure in the neck
In describing these symptoms, Dr. Sosa emphasizes how subtle they are. “These signs often develop slowly—over weeks, months or even years. It’s very rare to have a rapidly growing neck mass. If that does happen, it’s extremely concerning and more indicative of an aggressive form of thyroid cancer.”
The incredibly hopeful news: A 98% cure rate when caught early
When we talk about thyroid cancer, it’s important to know that it isn’t a single, uniform disease, Dr. Sosa points out. “It comes in many different types and ‘flavors,’” she says. “The most common category is called differentiated thyroid cancer, which arises from the thyroid follicles and broadly includes three subtypes.
One major subtype is papillary thyroid cancer, which now accounts for about 90 percent of all new thyroid cancer cases. The great news? “The overwhelming majority of differentiated thyroid cancers have an excellent prognosis—about a 98 to 99 percent cure rate at ten years—especially when identified and treated early,” Dr. Sosa notes.
Why women over 55 are diagnosed more often—and the surprising reason why
Age and sex are huge factors when it comes to thyroid cancer. Let’s take age first: “If you’re younger than 55, you can only be stage I or II,” reveals Dr. Sosa. “For those over 55, stages range from I to IV, with stage I being the least aggressive and stage IV the most. This reflects the general pattern that thyroid cancer aggressiveness tends to increase with age.”
When it comes to sex, women are diagnosed with thyroid cancer about four times more often than men—but the reason may surprise you. “Women tend to see doctors more regularly and undergo more thyroid ultrasounds—for everything from breast lumps to hormonal concerns,” says Dr. Sosa.
She notes that much of this disparity is likely due to detection bias rather than a true biological difference: because women are tested more frequently, they’re simply more likely to be diagnosed. It’s important to add, however, that when a man develops a thyroid nodule, it is more likely to be cancerous than a nodule in a woman.
3 additional thyroid cancer risk factors worth knowing about
Beyond age and sex, several other factors can increase the risk of thyroid cancer. Dr. Sosa explains:
Radiation exposure
Specifically, exposure to the head and neck during childhood or adolescence, she says. “This could come from rare events, such as a nuclear accident like Chernobyl—there have even been cases among patients who immigrated to the U.S. from areas affected by the fallout.
More commonly, the risk comes from radiation received as part of treatment for childhood or adolescent cancer.
Family history
Another important risk factor is family history, which can play a significant role in thyroid cancer risk. “Several inherited syndromes are linked to the disease,” explains Dr. Sosa. “For instance, medullary thyroid cancer—a rare type that is not a differentiated thyroid cancer—has a hereditary component. About a quarter of medullary thyroid cancer cases are inherited.
Obesity
“I’ve done some research that suggests people with higher body weight who have thyroid cancer are more likely to have larger tumors,” she says. This is one more reason why maintaining a healthy weight through balanced nutrition and movement can support your overall health. (Check out some of our best weight-loss strategies.)
“You may be wondering whether having any of the above risk factors means you should undergo additional screening. The answer is no for people without symptoms, says Dr. Sosa. “This recommendation is based on guidance from the U.S. Preventive Services Task Force.” That goes back to the fact that for over 30 years thyroid cancer was overdiagnosed.
However, if you have any of the symptoms mentioned earlier or notice changes in your neck, it’s absolutely worth bringing them up with your doctor.
3 effective treatment options for small thyroid cancers
For very small thyroid cancers—those under one centimeter—newly updated guidelines now recommend several options, says Dr. Sosa:
- Lobectomy: If your thyroid cancer is between one and four centimeters and hasn’t spread beyond the thyroid, newer guidelines now recommend a less aggressive approach than in the past, she points out. “Instead of removing the entire thyroid, surgeons often favor removing just one lobe, particularly when tumors are closer to one centimeter. This smaller operation offers the same long-term survival while lowering the risk of surgical complications. Most people with thyroid cancer fall into this category, often described as having ‘low-risk’ disease.”
- Active surveillance, meaning the cancer is closely monitored with regular ultrasounds and surgery is only done if it grows. This option recognizes that some very small cancers may never cause problems and allows you to avoid unnecessary surgery.
- Ablation, the third, newest option, destroys the cancer using heat, cold, alcohol or radiofrequency energy.
Treatment options for larger thyroid cancers: What to expect
If thyroid cancer is present on both sides of the thyroid or if a tumor is larger than four centimeters, doctors typically recommend a total thyroidectomy, meaning the entire thyroid is removed, explains Dr. Sosa.
“This approach carries more risk than partial surgery, and because the body can’t function without the thyroid, it also means a lifelong commitment to taking a daily thyroid hormone pill.” The good news? This medication is highly effective, well-tolerated by most people and allows you to live a full, active life. Two more treatment options:
Radioactive iodine
Some intermediate- and all high-risk tumors are treated with radioactive iodine. “In the past, nearly everyone received radioactive iodine, but today it’s used in a much smaller group of patients,” says Dr. Sosa. The treatment is given as a pill, usually on an outpatient basis, and it works by targeting remaining thyroid tissue or cancer cells. While effective, especially for larger tumors or cancers that have spread beyond the thyroid, it does carry risks, which is why we’ve used it less and less over time.”
Small molecule therapies
For advanced cases that don’t respond to radioactive iodine, such as cancers that are difficult to remove surgically or have spread beyond the neck, newer treatments are available, she assures.
These include targeted therapies, often taken as pills, that are tailored to the specific genetic makeup of a tumor. “While they aren’t traditional chemotherapy, they’ve been shown to be effective and represent an important option for patients with advanced disease.”
The one crucial question to ask your doctor
If you need treatment for thyroid cancer, Dr. Sosa urges you to see an endocrinologist or surgical endocrinologist with expertise in thyroid disease and thyroid cancer. “An important question to ask your physician or surgeon is how many of these cases they treat each year,” she says.
“There’s a clear association between how many procedures a surgeon performs and patient outcomes—surgeons who perform more thyroid surgeries tend to have fewer complications and better results.”
The bottom line on thyroid cancer: Most patients have an excellent prognosis
The most important takeaway is that the overwhelming majority of people with differentiated thyroid cancer have an excellent prognosis, especially if identified early, assures Dr. Sosa. “In the end, the goal is to find an experienced, multidisciplinary clinical team that can support you in your decision-making and ensure the most personalized and appropriate treatment for your specific situation.”
If you or someone you love has thyroid cancer, she encourages visiting a thyroid cancer survivors’ group called ThyCa. “All of their resources are publicly available. It can be very helpful for patients—whether they have confirmed or suspected thyroid cancer—to connect with others who have been through similar experiences and gain support.”
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