U Assessment

HISTORY. Most patients present with an asymptomatic neck mass. They may also have complaints of neck discomfort, hoarseness, dysphagia (difficulty swallowing), feeling as if they are "breathing through a straw," and rapid nodule growth. Elicit a family history because some forms of thyroid cancer are inherited. If the thyroid has been completely destroyed by cancer cells, the patient may report a history of sensitivity to cold, weight gain, and apathy from hypothyroidism. If the thyroid has become overstimulated, the patient may describe signs of hyperthyroidism: sensitivity to heat, nervousness, weight loss, and hyperactivity. Changes in thyroid function may also lead to gastrointestinal changes such as diarrhea and anorexia.

PHYSICAL EXAMINATION. Observe the patient's neck, noting any mass or enlargement. Patients with anaplastic thyroid cancer may have a rapidly growing tumor that distorts the neck and surrounding structures. Palpate the thyroid gland for size, shape, configuration, consistency, tenderness, and presence of any nodules. Describe the number of nodules present and whether the nodule is smooth or irregular, soft or hard, or fixed to underlying tissue. Note the presence of enlarged cervical lymph nodes, which occur in 25% of patients with the disease. Auscultation may reveal bruits if the thyroid enlargement results from an increase in TSH, which increases thyroid circulation and vascularity.

PSYCHOSOCIAL. Assess the patient's ability to cope with the sudden illness and the diagnosis of cancer. Determine what a diagnosis of cancer means to the patient. Consider the type of cancer (and the speed of cancer growth) when assessing the patient's and family's response to the disease.

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