Patients with DTC typically present with a solitary thyroid nodule or with enlarged lymph nodes of the neck. The diagnosis of thyroid cancer usually begins with the palpation of an asymptomatic thyroid nodule. In about half of the patients, a doctor discovers the nodule during a routine physical examination. In the other half of the situations, it is the patient who first notices a thyroid asymmetry.

Ultrasound and thyroid scintigrams are the first-line diagnostic tools in the case of suspected carcinoma. Ultrasound features that indicate cancers are a solid hypoechoic tumor with irregular borders. A thyroid scan shows a nonfunctioning or cold lesion. Fine-needle aspiration (FNA) for cytologic diagnosis is the initial invasive evaluation in most patients (35). FNA can make the diagnosis of PTC but it cannot be used to distinguish between follicular adenoma and carcinoma. The diagnosis of micro- or occult carcinoma is usually made during pathologic examination of a multinodular goiter or after the FNA biopsy of an incidental nodule found on ultrasonography.

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