For many patients, being told they have a thyroid nodule instantly raises red flags. Do I have cancer? Will I need surgery? Should I be worried?
The answer to these questions is usually, but not always, “no.” Thyroid nodules are lumps that form within your thyroid, a butterfly shaped gland located at the base of your neck. Nodules can be solid or contain a variable amount of fluid. If they are completely fluid-filled, they are called thyroid cysts.
Thyroid nodules are more common in women compared to men and more likely to occur as you get older. The exact reason why some people get thyroid nodules and others don’t is not known, but nodules tend to run in families.
Most thyroid nodules are benign (non-cancerous) and cause no problems if left untreated. However, approximately 5 to 10 percent of thyroid nodules are cancerous – but even then, a patient might not need surgery right away because most thyroid cancers grow slowly.
If you have been diagnosed with a thyroid nodule, the first step is to see an endocrinologist – a doctor who specializes in conditions of the endocrine glands, such as the thyroid.
“Most thyroid nodules are benign (non-cancerous) and cause no problems if left untreated. However, approximately 5 to 10 percent of thyroid nodules are cancerous – but even then, a patient might not need surgery right away because most thyroid cancers grow slowly.”
How would you know you have a thyroid nodule?
Common reasons you can be referred to the endocrinology department for evaluation of thyroid nodules include:
- The nodule was discovered during
an imaging test for an unrelated reason, such as a carotid doppler ultrasound
or a CT scan that includes your neck.
- Your primary care doctor felt a
lump in your neck during a routine physical examination (very small nodules under
1 cm usually can’t be felt).
- You have symptoms such as swelling in the neck or front of the throat, trouble swallowing, or a hoarse voice.
A thyroid ultrasound is the best way to evaluate these nodules. We use an ultrasound machine to see if any nodules are present, their size, and whether there are signs that the nodule might be cancerous.
We do not usually worry about nodules that are smaller than 1 cm in size or if we see a thyroid cyst (fluid-filled nodule), as they are usually benign. Other nodules either should be followed on ultrasound or evaluated further with a biopsy, depending on what they look like.
What happens next?
Once the presence of nodules is confirmed, it is important to get a blood test to check the function of your thyroid gland. If your thyroid is producing too much thyroid hormone (hyperthyroidism), we can do a radioactive iodine uptake and scan. This study involves swallowing a pill and taking a picture the next day to tell us whether the nodule is making too much thyroid hormone. If it is, then it is called a “hot nodule” and doesn’t require a biopsy.
If a nodule is large or looks suspicious, we will do a fine needle aspiration biopsy, which involves using thin needles to take tissue samples of a tiny portion of the nodule that is evaluated in the lab for cancer cells. We usually save two samples – if the pathologist can’t tell whether cancer is present in the first sample, we can send the second for molecular testing. This is an advanced type of testing to help us assess the risk of thyroid cancer in the nodule and determine the best course of action.
When to be more proactive
Although most thyroid nodules are benign, some can harbor thyroid cancer. And some types of thyroid cancer are more aggressive than others. You should be more proactive in seeing an endocrinologist if you have any of the following symptoms:
- A lump in your neck that appears to be growing
- Swelling or pain in the neck
- Hoarse voice
- Persistent cough
- Trouble breathing or swallowing
Also see an endocrinologist if you have been diagnosed with a thyroid nodule and have any of the following risk factors for thyroid cancer:
- An immediate family member who was diagnosed with thyroid cancer
- Any kind of radiation exposure, especially to the head and neck area
Thyroid nodule treatment options
Most nodules, benign or cancerous, are not an immediate health risk. However, as with most conditions, treating the issue early is less intensive and less invasive than waiting until it becomes serious.
The treatment your endocrinologist recommends will depend upon the nodule characteristics:
- Large nodules: If your nodule is so large that it is making it hard to swallow or breath, then surgical removal is an option for you. If it is only on one side of the thyroid and is not cancerous, we often can leave the other half of the thyroid in so you do not have to take thyroid medication for the rest of your life. Other more minimally invasive therapies such as radiofrequency ablation can also be used instead; however, these are not as common.
- Hot nodules: This type of nodule can cause symptoms of hyperthyroidism (overactive thyroid) such as weight loss, fatigue, diarrhea, heart palpitations, and other potentially serious health issues. We can treat hot nodules either with radioactive iodine therapy, which is a single dose of oral medication that destroys the over-active thyroid cells in the nodule, or by surgically removing the side with the nodule. Another option is medication, but it must be taken long-term, so is not preferred.
- Cancerous nodules (thyroid cancer): These nodules usually require surgery that removes your entire thyroid gland. However, if the cancer is very small, sometimes you can get away with just taking out the side with the cancer. Larger or aggressive cancerous nodules require removal of the whole thyroid and sometimes subsequent radioactive iodine therapy.
- Fluid-filled nodules (thyroid cysts): It is usually fine to leave cysts untreated, especially if they are causing no problems. Sometimes these can keep collecting more fluid and get bigger, causing difficulty swallowing, a choking sensation, or a feeling of pressure in your throat. Draining the cyst, which is done by inserting a thin needle and removing the fluid, can relieve these symptoms. However, fluid will often reaccumulate. In these situations, we offer a treatment called percutaneous alcohol ablation in which we drain the cyst and inject it with alcohol. The alcohol prevents the cyst from refilling with fluid.
If you are diagnosed with a thyroid nodule, don’t panic. The majority of thyroid nodules are benign, and most do not require surgery. See an endocrinologist to find the most effective treatment option for you and to get your questions answered.