Enlarged lymph nodes
Papillary carcinomas initially metastasize to the pre-tracheal and paratracheal lymph nodes. Then, patients start having cervical lymphadenopathy, usually with an already swollen thyroid gland. In early cases, when the primary mass is not large, patients may still have some cervical lymph node enlargements. Lymphatic metastasis in follicular carcinomas is uncommon. In contrast, anaplastic carcinoma can spread to the cervical lymph nodes and invade their capsule.