Thyroid Nodule
overview
The thyroid gland is a butterfly-shaped gland located in the lower anterior neck. It produces thyroid hormones that help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally.
A thyroid nodule is a growth of cells that forms a lump in the thyroid. Overall, thyroid nodules are relatively common, affecting 5-20% of the population1. Females have a higher likelihood of developing thyroid nodules compared to men. Patients above 60 years of age have about a 50% chance of having a thyroid nodule. Most nodules are benign, while 5-15% are malignant, or cancerous.
Did you know that 75% of thyroid surgeries are performed by surgeons who do less than 10 thyroid surgeries in a year? Our experienced thyroid surgeons are considered high volume thyroid/parathyroid surgeons. Studies prove that high volume thyroid surgeons have lower complication rates. Our surgeons can perform same-day thyroid surgeries with smaller incisions, minimal pain, and no drains.
Thyroid Nodule
overview
The thyroid gland is a butterfly-shaped gland located in the lower anterior neck. It produces thyroid hormones that help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally.
A thyroid nodule is a growth of cells that forms a lump in the thyroid. Overall, thyroid nodules are relatively common, affecting 5-20% of the population1. Females have a higher likelihood of developing thyroid nodules compared to men. Patients above 60 years of age have about a 50% chance of having a thyroid nodule. Most nodules are benign, while 5-15% are malignant, or cancerous.
Did you know that 75% of thyroid surgeries are performed by surgeons who do less than 10 thyroid surgeries in a year? Our experienced thyroid surgeons are considered high volume thyroid/parathyroid surgeons. Studies prove that high volume thyroid surgeons have lower complication rates. Our surgeons can perform same-day thyroid surgeries with smaller incisions, minimal pain, and no drains.
Symptoms
Most thyroid nodules are not associated with any symptoms. They are typically diagnosed either by a palpable mass near the midline of the neck or found incidentally on imaging of the neck.
Some symptoms may exist, but these are not very common:
- Food getting stuck while swallowing at the level of the thyroid gland
- Shortness of breath when lying down flat
- Hoarseness
Occasionally patients may have a hyperfunctioning thyroid nodule. These patients have symptoms of hyperthyroidism:
- Heart racing
- Increased sweating
- Increased bowel movements
- Anxiety
- Tremor
- Weight loss
Causes
The cause of most thyroid nodules is unknown. Some patients develop thyroid nodules for the reasons listed below:
Hashimoto’s Thyroiditis
An autoimmune disorder associated with chronic inflammation of the thyroid gland and hypothyroidism.
Hyperfunctioning Nodule
Some nodules produce excess thyroid hormone leading to hyperthyroidism.
Iodine Deficiency
Extremely rare in America, but a known cause of thyroid enlargement and nodules.
Cancer
Malignancy causes excessive tissue growth resulting in a nodule. Risk factors include a family history of thyroid cancer and large amounts of radiation exposure to the neck area.
Symptoms
Most thyroid nodules are not associated with any symptoms. They are typically diagnosed either by a palpable mass near the midline of the neck or found incidentally on imaging of the neck.
Some symptoms may exist, but these are not very common:
- Food getting stuck while swallowing at the level of the thyroid gland
- Shortness of breath when lying down flat
- Hoarseness
Occasionally patients may have a hyperfunctioning thyroid nodule. These patients have symptoms of hyperthyroidism:
- Heart racing
- Increased sweating
- Increased bowel movements
- Anxiety
- Tremor
- Weight loss
Causes
The cause of most thyroid nodules is unknown. Some patients develop thyroid nodules for the reasons listed below:
Hashimoto’s Thyroiditis
An autoimmune disorder associated with chronic inflammation of the thyroid gland and hypothyroidism.
Hyperfunctioning Nodule
Some nodules produce excess thyroid hormone leading to hyperthyroidism.
Iodine Deficiency
Extremely rare in America, but a known cause of thyroid enlargement and nodules.
Cancer
Malignancy causes excessive tissue growth resulting in a nodule. Risk factors include a family history of thyroid cancer and large amounts of radiation exposure to the neck area.
Diagnosis
Some thyroid nodules are found incidentally on imaging of the neck with a CT or MRI scan. While these other imaging techniques may detect a thyroid nodule, the best technique to characterize a thyroid nodule is ultrasound.
During your office visit, the following may be used to diagnose a thyroid nodule:
Ultrasound
This is an imaging technique that does not use radiation but rather uses sound waves. It is the best imaging technique to accurately measure and characterize thyroid nodules. Certain ultrasound characteristics will determine whether or not a thyroid nodule will need to be biopsied. For example, nodules less than one centimeter in size do not need to be biopsied.
Bloodwork
Evaluating thyroid function via bloodwork is important because some nodules secrete an excess amount of thyroid hormone. Other bloodwork may also be ordered as determined by the physician.
Thyroid Uptake Scan
Recommended for patients with hyperthyroidism and a thyroid nodule.
Fine Needle Aspiration
If certain characteristics are present on ultrasound, a tissue sample of the nodule will need to be taken and evaluated by a pathologist to determine whether or not the nodule appears to be cancer or not. The biopsy is performed in the office with a small needle, after numbing the skin with a local anesthetic. The sample is then sent for evaluation by a pathologist, with results typically in one week. Roughly 70-80% of biopsies are benign, 5% are cancerous, and 10% are suspicious for cancer. In up to 20% of biopsies, a definitive diagnosis cannot be made; in these situations, re-biopsy or molecular testing may be beneficial.
CT Scan
For some patients, the bottom portion of the thyroid gland is not fully seen on ultrasound. When this is the case, a CT scan may be ordered to determine the inferior extent of the gland.
Diagnosis
Some thyroid nodules are found incidentally on imaging of the neck with a CT or MRI scan. While these other imaging techniques may detect a thyroid nodule, the best technique to characterize a thyroid nodule is ultrasound.
During your office visit, the following may be used to diagnose a thyroid nodule:
Ultrasound
This is an imaging technique that does not use radiation but rather uses sound waves. It is the best imaging technique to accurately measure and characterize thyroid nodules. Certain ultrasound characteristics will determine whether or not a thyroid nodule will need to be biopsied. For example, nodules less than one centimeter in size do not need to be biopsied.
Bloodwork
Evaluating thyroid function via bloodwork is important because some nodules secrete an excess amount of thyroid hormone. Other bloodwork may also be ordered as determined by the physician.
Thyroid Uptake Scan
Recommended for patients with hyperthyroidism and a thyroid nodule.
Fine Needle Aspiration
If certain characteristics are present on ultrasound, a tissue sample of the nodule will need to be taken and evaluated by a pathologist to determine whether or not the nodule appears to be cancer or not. The biopsy is performed in the office with a small needle, after numbing the skin with a local anesthetic. The sample is then sent for evaluation by a pathologist, with results typically in one week. Roughly 70-80% of biopsies are benign, 5% are cancerous, and 10% are suspicious for cancer. In up to 20% of biopsies, a definitive diagnosis cannot be made; in these situations, re-biopsy or molecular testing may be beneficial.
CT Scan
For some patients, the bottom portion of the thyroid gland is not fully seen on ultrasound. When this is the case, a CT scan may be ordered to determine the inferior extent of the gland.
Available Treatments
Treatment of thyroid nodules generally falls into the following categories:
Watchful Waiting With Serial Ultrasounds
For thyroid nodules that are not symptomatic and either do not meet biopsy criteria or for which a benign biopsy result has been obtained, serial ultrasounds are the management of choice. The frequency of the ultrasounds will be determined by the surgeon. Should the thyroid nodule grow significantly in size or start to cause bothersome symptoms, a repeat biopsy or surgical excision may be performed.
Medication
For patients with a low functioning thyroid gland, hormone supplementation is recommended. For those with a hyperfunctioning thyroid gland, anti-thyroid medications are recommended. Medication management is often performed by an endocrinologist.
Radioactive Iodine Therapy
Typically reserved for patients with a hyperfunctioning thyroid nodule or gland that is not responsive to anti-thyroid medications.
Thyroidectomy
Surgical removal of half or all of the thyroid gland is recommended for patients with a biopsy result suspicious for cancer. Surgery may also be recommended for patients with hyperthyroidism that is not controlled well with medication, or for patients with large thyroid glands that result in compressive symptoms such as difficulty swallowing and shortness of breath when lying down flat.
Available Treatments
Treatment of thyroid nodules generally falls into the following categories:
Watchful Waiting With Serial Ultrasounds
For thyroid nodules that are not symptomatic and either do not meet biopsy criteria or for which a benign biopsy result has been obtained, serial ultrasounds are the management of choice. The frequency of the ultrasounds will be determined by the surgeon. Should the thyroid nodule grow significantly in size or start to cause bothersome symptoms, a repeat biopsy or surgical excision may be performed.
Medication
For patients with a low functioning thyroid gland, hormone supplementation is recommended. For those with a hyperfunctioning thyroid gland, anti-thyroid medications are recommended. Medication management is often performed by an endocrinologist.
Radioactive Iodine Therapy
Typically reserved for patients with a hyperfunctioning thyroid nodule or gland that is not responsive to anti-thyroid medications.
Thyroidectomy
Surgical removal of half or all of the thyroid gland is recommended for patients with a biopsy result suspicious for cancer. Surgery may also be recommended for patients with hyperthyroidism that is not controlled well with medication, or for patients with large thyroid glands that result in compressive symptoms such as difficulty swallowing and shortness of breath when lying down flat.
Services We Provide
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In-office thyroid ultrasound
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In-office ultrasound guided biopsy
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Thyroidectomy
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Neck dissection
Services We Provide
-
In-office thyroid ultrasound
-
In-office ultrasound guided biopsy
-
Thyroidectomy
-
Neck dissection
i Medici, M., Liu, X., Kwong, N., Angell, T. E., Marqusee, E., Kim, M. I., & Alexander, E. K. (2016). Long- versus short-term follow-up of cytologically benign thyroid nodules: a prospective cohort study. BMC Medicine.