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Most thyroid nodules will be asymptomatic, and present after being noticed by the patient. Alternatively the nodule may be discovered by the doctor while examining the neck for unrelated conditions.

The key elements of history helping to distinguish thyroid cancer from other causes of a thyroid nodule relate to the known risk factors. These include age <20 or >70, external irradiation to the neck during childhood or adolescence, family history of thyroid cancer (seen in medullary cancer of the thyroid or multiple endocrine neoplasia type 2). The presence of an accompanying hoarse voice, dyspha-gia or neck pain, rapid nodule enlargement, symptoms of compression, including stridor and dyspnea, or enlarged lymph nodes are signs of potential invasion of the cancer to local structures [7].

Historical features that reduce the chance of a cancer include: family history of Hashimoto's thyroiditis or autoimmune thyroid disease; family history of benign thyroid nodule or goiter; symptoms of hypothyroidism or hyper-thyroidism [7]. Living in an area of iodine deficiency increases the chance of multinodular goiter [8].

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