Signs that thyroid cancer has spread depend on the location of the spread and the type of thyroid cancer. Common signs include a lump in the neck, difficulty swallowing, and hoarseness.

Signs and symptoms of thyroid cancer typically depend on how far the cancer has spread. In the earlier stages of thyroid cancer, you may not experience any symptoms. If symptoms do occur, they typically affect the area around your thyroid gland, like your throat and neck.

When thyroid cancer spreads to other areas of your body (metastasizes), more widespread symptoms tend to show up. Here’s what to look out for.

When thyroid cancer spreads and becomes metastatic thyroid cancer, it may cause different symptoms depending on the part of your body affected. Later stages of thyroid cancer may also cause more noticeable symptoms in the area around your thyroid.

Metastatic thyroid cancer often spreads to the following locations:

  • lymph nodes
  • lungs
  • bones
  • liver

Signs that thyroid cancer has spread may differ depending on the location of the cancer.

Thyroid

Metastatic thyroid cancer may cause symptoms in your neck and throat, near your thyroid gland.

Symptoms can include:

  • a lump in your neck
  • hoarseness
  • soreness or pain in the front of your neck
  • difficulty swallowing
  • persistent cough
  • trouble breathing

When thyroid cancer metastasizes, the lymph nodes in your neck are one of the most commonly affected areas. This is known as localized spread. Symptoms can include:

  • persistently enlarged lymph nodes in your neck
  • a rapidly growing lump
  • hoarseness when you speak

You have lymph nodes throughout your body. In rare cases, thyroid cancer may spread to these other lymph nodes.

Lungs

In some cases, thyroid cancer spreads beyond your thyroid and lymph nodes. This is known as distant metastasis. The lungs are the most common site of distant metastasis in thyroid cancer.

Most people with thyroid cancer that’s spread to the lungs don’t experience any symptoms. But some do.

Symptoms may include:

  • coughing up blood
  • dry cough
  • difficulty breathing

Bones

Thyroid cancer may also spread to your bones, but this is uncommon. Bone metastasis develops in around 4% of people with thyroid cancer.

If thyroid cancer does spread to your bones, it typically affects your:

  • spine
  • pelvis
  • ribs
  • femur (thighbone)

Symptoms in these bones may include:

  • bone pain
  • broken bones
  • nerve pain in your spine

Liver

In rare cases, thyroid cancer spreads to your liver. This happens in less than 1% of people who develop thyroid cancer.

Because this type of metastasis is so rare, researchers don’t know a lot about it or its symptoms. Symptoms could include persistent abdominal pain and unexplained weight loss.

Papillary thyroid cancer is the most common type of thyroid cancer. It’s sometimes referred to as differentiated thyroid cancer.

Papillary thyroid cancer usually affects just one lobe of your thyroid gland. It typically grows slowly, but if it spreads, it can metastasize to the lymph nodes in your neck.

Metastatic papillary thyroid cancer can often be successfully treated.

Follicular cancer is the second most common type of thyroid cancer. When it spreads, it typically affects your lungs or bones. It can cause many of the symptoms listed above.

In most cases, treatment outcomes for people with follicular thyroid cancer are very good.

Medullary thyroid cancer is less common, affecting only around 4% of all people with thyroid cancer. When it spreads, medullary thyroid cancer tends to affect your lymph nodes, lungs, or liver.

Medullary thyroid cancer tends to be more difficult to treat than other forms of thyroid cancer.

This type of cancer spreads quickly. It can affect the lymph nodes in your neck as well as other parts of your body.

Anaplastic thyroid cancer, also known as undifferentiated carcinoma, is rare. It accounts for only 2% of people with thyroid cancer. It can develop on its own or from an existing papillary or follicular cancer.

People with anaplastic thyroid cancer have a poorer outlook than those with other types of thyroid cancer.

Here are some common questions about thyroid cancer and how it spreads.

How long can you have thyroid cancer without knowing?

It’s possible to have thyroid cancer and not know it for a long time. Symptoms can be vague or mistaken for other, less serious health issues. For some people, it can be months or even years before they get a diagnosis.

Where is the first place thyroid cancer spreads?

It depends on the type:

  • Papillary: Papillary thyroid cancer is most likely to spread to nearby lymph nodes in your neck.
  • Follicular: Follicular thyroid cancer tends to metastasize to your lungs or bones.
  • Medullary: Medullary thyroid cancer can spread to your lymph nodes, lungs, or liver.
  • Anaplastic: Anaplastic thyroid cancer may metastasize to the lymph nodes in your neck or other parts of your body.

Where is the most common place for thyroid cancer to spread?

Metastatic thyroid cancer is most likely to spread to your lymph nodes. Depending on the type of thyroid cancer you have, it may also spread to your bones, lungs, and liver.

Most people with thyroid cancer will have a localized form, but it’s possible for it to spread to other areas of your body. It most commonly affects your lymph nodes. But it may also metastasize to your bones, lungs, and liver.

Catching metastatic thyroid cancer as early as possible can help improve your treatment outcomes.