Thyroid Nodules

Thyroid Nodules

Symptoms

About 90 to 95% of all thyroid nodules are not harmful or cancerous. A person may not be aware that they have a nodule, but if it starts to grow, they may notice it. A doctor may feel it when he or she carefully examines the thyroid gland.

Nodules should be checked by a doctor. Tests, especially a fine needle aspiration, can usually tell if a nodule is harmless and which treatment would be best. A nodule may be cancerous if the lymph nodes under the jaw are swollen and if it:

Grows quickly and feels solid

Causes pain

Feels hard

Causes difficulty with swallowing or breathing

Causes a person to be hoarse

If a patient has had radiation treatment around the head or neck areas, they should tell their doctor because this can increase your chances of having nodules and cancer.

Among people who have thyroid nodules, thyroid cancer is found in about 8% of men and 4% of women. To determine whether a nodule may be harmful, the doctor may:

1. Perform a fine-needle aspiration biopsy, in which a thin needle is inserted into the nodule to remove cells and/or fluid samples from the nodule for examination under a microscope;

2. Perform a thyroid scan with a radioactive marker to learn whether the nodule is functioning normally;

3. Take blood and perform several tests, including measuring levels of thyroid-stimulating hormone (TSH), antibody tests, and calcitonin tests

4. Perform a thyroid hormone treatment and see if the nodule shrinks, which probably means it is not malignant. (The use of thyroid hormone for the purpose of shrinking nodules, and therefore helping to assess their chance of harboring malignancy, is being used less frequently now than in the past. This change in approach is related to the increased utility of the fine needle aspiration, recognition that even thyroid nodules with thyroid cancer may get somewhat smaller, and because there may be adverse side effects on the heart and bones from the thyroid hormone medication. The dose of thyroid hormone used to shrink thyroid nodules is higher than that used for simple replacement purposes. Thyroid hormone replacement should not be associated with these adverse effects.)

Treatments

Only about 5% of thyroid nodules are cancerous. If you have thyroid cancer, please remember that most patients recover well from this type of cancer. Most thyroid cancers need to be removed by surgery, after which radioactive iodine therapy may be needed to destroy any remaining thyroid cells.

Other types of nodules, even if they are not cancerous, may also need to be removed. Most specialists recommend a total rather than partial removal of the thyroid gland. The thyroid gland and the nodules within it are removed by surgery (thyroidectomy) with T4 treatment afterward.

Following surgery and subsequent radioactive iodine therapy, patients with thyroid cancer do still require monitoring for many years. The monitoring varies between patients but typically includes periodic blood tests, including tests for thyroid function and thyroglobulin levels (a tumor marker), as well as possibly radiologic studies to include sonograms, CT scans, MRI scans and radioactive scans. The use of these tests varies based on the type of tumor, and may also vary between institutions.

Overfunctioning ("autonomous") nodules are almost always not malignant, but they may act like thyroid tissue, produce extra hormones, and cause hyperthyroidism (too much hormone production). These nodules may be surgically removed or treated with radioactive iodine.

If a nodule has fluid it is called a cyst. To treat it, the doctor will probably drain it or monitor it for change. If these nodules bleed a lot or come back, then they may need to be removed.