Signs and symptoms that thyroid cancer is spreading

By | February 28, 2024

Medically reviewed by Kelly Wood, MD

Thyroid cancer can become metastatic when cancer cells that originate in the thyroid gland spread to other parts of the body through the bloodstream or lymphatic system (tissue, blood vessels, and organs that return white blood cells to the bloodstream). Only 3% of cases are metastatic at the time of diagnosis.

Once thyroid cancer has spread, it can affect various organs and tissues. Early detection of thyroid cancer is important to initiate treatment and improve outcomes. Thyroidectomy (removal of the thyroid gland) and other treatments can be performed to prevent metastases and possibly cure thyroid cancer.

Most cases of thyroid cancer (64%) are diagnosed while the cancer is localized to the thyroid gland, and 30% when the cancer has spread only to regional lymph nodes, but not to distant sites.

This article discusses the most common sites of metastases, the symptoms associated with metastatic disease, the types of thyroid cancer and their progression.

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Where in the body does thyroid cancer spread?

The most common sites of thyroid cancer metastasis are:

  • Lymph nodes in the neck

  • Lungs

  • Bones

  • Liver

  • Brain

  • Adrenal glands

The lymph nodes in the neck are the most common sites of early metastases due to the direct drainage from the thyroid gland to these nodes via the lymphatic system.

As the cancer progresses, it spreads through the bloodstream to distant locations. The exact pattern of thyroid cancer metastasis can vary depending on the specific type of thyroid cancer and the characteristics of the tumor.

Stages of thyroid cancer

Thyroid cancer is assigned a stage of 1 to 4 upon diagnosis. The type of cancer and age at diagnosis are taken into account, based on the following:

Invisible symptoms of metastatic thyroid cancer

In the early stages of thyroid cancer, it is common for there not to be many noticeable signs or for the symptoms experienced to be overlooked or attributed to something else. These early signs and symptoms may include:

Metastatic thyroid cancer can also present with nonspecific or invisible symptoms, which can make diagnosis difficult. A person may experience symptoms attributed to other conditions. Symptoms may include:

  • Cough

  • Fatigue

  • Unexplained weight loss

  • Difficulty swallowing

  • Hoarse voice

As the cancer progresses and different organs are involved, other symptoms may occur, including:

  • Shortness of breath

  • Bone pain

  • Stomach ache

These subtle symptoms of metastatic thyroid cancer demonstrate the importance of regular monitoring and visits to a healthcare provider to detect metastases early in those previously treated for thyroid cancer.

Types of thyroid cancer and progression

Metastatic thyroid cancer is one of the few different types of thyroid cancer. Each has its own characteristics and progression patterns. The most common types of metastatic thyroid cancer are:

The rate at which thyroid cancer spreads can vary significantly and depends on several factors, such as:

In general, thyroid cancer tends to grow slowly, especially in the case of papillary and follicular carcinomas (malignant tumors), the most common types. In the early stages it is very treatable.

Papillary thyroid cancer is the most common form of thyroid cancer and usually progresses slowly. If it spreads, it is often found in the lymph nodes in the neck before traveling to distant organs.

Follicular thyroid cancer, the second most common type of thyroid cancer, tends to spread through the bloodstream to distant organs, such as the lungs or bones.

Medullary thyroid cancer is much less common than papillary or follicular types, occurring in 3% to 5% of all thyroid cancers. It is also more aggressive than these species. This type can spread to the lymph nodes, lungs, liver or bones.

Anaplastic thyroid cancer, a rare form of thyroid cancer, is very aggressive and rapidly spreads to nearby tissues and distant organs, often leading to a poor prognosis.

Metastatic thyroid cancer after thyroidectomy

A common treatment for early-stage thyroid cancer is the surgical removal of the thyroid gland in a procedure called a thyroidectomy. Often it is done in an attempt to cure thyroid cancer.

Although the primary tumor may have been removed, cancer cells may have already spread to other parts of the body before surgery or develop metastases later.

After a thyroidectomy, the person usually follows a schedule of careful monitoring to detect any signs of metastasis. This may include regular imaging tests such as ultrasound, computed tomography (CT), diagnostic iodine-131 scans, or positron emission tomography (PET) to assess the presence of cancer cells in nearby lymph nodes or distant organs.

In addition, blood tests that measure thyroid hormone levels and tumor markers may be performed to monitor disease progression. Treatment options for metastatic thyroid cancer after thyroidectomy depend on several factors, including the size and location of metastases, overall health status, and characteristics of the tumor.

Treatment options may include:

  • Radioactive iodine therapy: Thyroid cells take up iodine, so administering a large dose of radioactive iodine can kill the remaining thyroid cells.

  • Targeted therapy: Tyrosine kinase inhibitors such as Nexavar (sorafenib) and Lenvima (lenvatinib) target the pathways that the cancer cells use to grow.

  • Chemotherapy: Drugs are given that damage or kill activity-distributing cells, such as cancer cells.

  • External radiation: High-energy rays or particles are used to kill cancer cells in a specific location.

Collaboration between surgeons, endocrinologists (specialists in hormonal disorders), oncologists (cancer specialists) and other healthcare providers is important in the treatment of metastatic thyroid cancer after thyroidectomy.


Thyroid cancer, while not uncommon and often highly treatable, can spread to other parts of the body, which is called metastatic thyroid cancer. It can sometimes go unnoticed because the symptoms can be subtle. Common areas it spreads to the lymph nodes, lungs, bones, liver, brain and adrenal glands.

Early signs may include a lump in the neck, voice changes, or difficulty swallowing. Symptoms such as fatigue, weight loss, and bone pain may develop as it progresses.

There are several types of thyroid cancer, some of which grow slowly and others that are more aggressive. After surgery to remove the thyroid gland, regular check-ups are important to detect any spread early.

Treatment options include radioactive iodine therapy, targeted therapy, chemotherapy, and radiation. Teamwork and collaboration between healthcare providers is necessary for the best care.

Read the original article about Verywell Health.

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