Thyroid Nodules Introduction

Thyroid nodules - Diagnosis and Treatment

Thyroid nodules are one of those things you never really give much thought to unless they are getting in the way of swallowing, making your voice hoarse, or doing some other thing to grab your attention. You might have felt a lump in your neck or noticed some of your collared shirts fit tighter than usual. Your doctor might also come across them in a routine physical exam.

This lens will focus on thyroid nodules and will explore what they are, their diagnosis and treatment.

What is a thyroid nodule?

Taken from: http://www.endocrineweb.com/nodule.html

Thyroid nodules are lumps which commonly arise within an otherwise normal thyroid gland. Often these abnormal growths of thyroid tissue are located at the edge of the thyroid gland so they can be felt as a lump in the throat. When they are large or when they occur in very thin individuals, they can even sometimes be seen as a lump in the front of the neck. The following is a list of facts regarding thyroid nodules:

One in 12 to 15 young women has a thyroid nodule

One in 40 young men has a thyroid nodule

More than 95 percent of all thyroid nodules are benign (non-cancerous growths)

Some are actually cysts which are filled with fluid rather than thyroid tissue

Most people will develop a thyroid nodule by the time they are 50 years old

The incidence of thyroid nodules increases with age
- 50% of 50 year olds will have at least one thyroid nodule
- 60% of 60 year olds will have at least one thyroid nodule
- 70% of 70 year olds will have at least one thyroid nodule

Three questions that should be answered about all thyroid nodules:

There are 3 critical factors that must be explored and answered:

1. Is the nodule one of the few that are cancerous?

2. Is the nodule causing trouble by pressing on other structures in the neck?

3. Is the nodule making too much thyroid hormone?

If any of the above questions are answered YES,
then medical or surgical treatment is required.

How are thyroid nodules diagnosed?

Although most patients with thyroid nodules are
asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease.

One of the first steps in diagnosing a thyroid nodule is a careful physical examination of the entire head and neck area by a trained specialist. It is also important to test blood levels of thyroid hormone to check for excessive hormone production.

Specialized testing for thyroid nodules includes:

* Thyroid ultrasound
* Thyroid scan
* Fine needle aspiration biopsy with or without ultrasound guidance
* Core needle biopsy

How are thyroid nodules treated?

The primary treatment options for thyroid nodules include surgery and medical therapy. Nodules that are suspicious for cancer, growing, present in an enlarged gland, or found to be hyperfunctioning should be immediately treated by surgical removal. Thyroid nodules that are felt to be benign or low-risk for cancer can be monitored instead. This involves an examination of the nodule every 6 to 12 months with a physical examination by a doctor, a thyroid ultrasound, or both.

The following flow chart shows a course of diagnosis and treatment dependent upon nodule characteristics:

Chart taken from: Thyroid nodules and thyroid cancer
Emily J Mackenzie and Robin H Mortimer

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