The first symptom in most patients with thyroid cancer is a normal asymptomatic thyroid lump. Rarely, there are small metastatic thyroid cancers showing enlarged lymph nodes, pulmonary symptoms or destructive bone loss. The increased likelihood of cancer is due to the following factors: 1. age (younger patients are more likely to have it); 2. gender, if the patient is male (women have more thyroid cancers than men, two times more, but women have a higher ratio of goiter, about 8:1, so a nodule in a man should be considered more suspicious); 3. isolated nodules (multinodular lesions are usually benign unless the scan is clearly cold); 4. cold thyroid isotope scan History of head, neck, or chest irradiation, especially in infants and children (e.g., due to enlarged thymus or enlarged tonsils, acne, or lymphoma); 6. Fine, punctate, or sandy calcifications (papillary carcinoma) or homogeneous calcifications (medullary carcinoma) on X-ray; 7. Recent or rapid enlargement; 8. Stone hard texture. Needle aspiration biopsy is the best diagnostic method to distinguish benign from malignant if a skilled cytologist and biopsy technician are available.