Thyroid nodules are formations of abnormal thyroid cells that may develop on the thyroid organ mass. They are incredibly common in people of all ages and can be indicators of an overactive thyroid gland.
It is estimated that between 50 to 60 percent of healthy adults may have thyroid nodules. About half of Americans will have a thyroid nodule by the time they are 60 years old, according to statistics gathered by the American Thyroid Association. Even so, only a small percentage of patients had large enough nodules to be detectable by touch.
Most nodules generally cause no symptoms and do not impact the quality of one’s life. However, there is a chance of nodules causing some discomfort and potentially developing into cancer.
Taylor Brown, MD, a Washington University endocrine surgeon specializing in thyroid conditions, discusses symptoms and how to manage thyroid nodules and what steps to take to deal with malignant forms of the condition.
Typical symptoms
While there may be no symptoms for most people with nodules, in more advanced cases, whether cancerous or benign, nodules or multinodular goiters may cause difficulty swallowing or choking sensation. Voice changes and pain in the front of the neck are also associated with the onset of thyroid nodules.
Less commonly, thyroid nodules can overproduce thyroid hormone. These are called “hot” or “toxic” nodules. Thyroid hormone regulates the body’s metabolism and too much thyroid hormone can cause heart palpitations, tremors, weight-loss, increased appetite, frequent bowel movements and difficulty sleeping.
A thyroid nodule diagnosis might cause several questions to come to mind, but there is usually no immediate need to worry.
Taylor C. Brown, MD, MHS
A personal physician can typically detect a nodule and offer advice on the next steps. If surgery is necessary, an experienced endocrine surgeon can help you through the process from start to finish.
Diagnosing
Typically, if a nodule is detected by physician exam or imaging, a doctor will first recommend a laboratory test to measure thyroid stimulating hormone (TSH) level. This test will determine if thyroid hormone production is normal.
“Recent innovations in imaging technology have significantly enhanced our assessment of thyroid nodules,” says Dr. Brown. Using ultrasound imaging techniques, specialists are able to identify the slightest abnormalities—including thyroid nodules—and characterize the nodule. The size and ultrasound features of thyroid nodules are scored using the Thyroid Imaging Reporting & Data System (TI-RADS).
“If the thyroid nodule has a high TI-RADS score, or if the nodule is large in size, a thyroid fine needle aspiration may be recommended,” says Dr. Brown. “However, most nodules detected on ultrasound do not require biopsy and can be monitored with ultrasound on a yearly basis.”
Fine needle aspiration is a simple outpatient procedure. It is performed with a local anesthetic (e.g. lidocaine), like what is used at the dentist’s office and takes about 20 minutes. The nodule is sampled with a tiny needle and cells are evaluated by a cytopathologist and sent for molecular testing.
Medical intervention
A healthcare provider may recommend radioactive iodine to treat hyperfunctioning thyroid nodules. This non-invasive treatment method causes nodules to shrink, restoring normal thyroid function.
Surgery is the top recommended treatment option if nodules actively impede breathing and swallowing, or if they are cancerous or suspected of being cancerous.
The partial or complete removal of the thyroid gland is rarely used to treat nodules, depending on whether cancer is present and to what extent.
An endocrine surgeon will assess and recommend the best course of action so that patients can make the best plan for themselves.
Outlook
The prognosis for benign thyroid nodules is positive, very rarely requiring any medical intervention at all. Nodules that require surgery can readily be treated by an endocrine surgeon quickly to return patients to good health.
Individuals concerned for their thyroid health should reach out to their primary care providers. While it is possible to detect a thyroid abnormality for oneself, an endocrine specialist will help guide patients on what course of action to take.
To request an appointment with a Washington University endocrine surgeon, please get in touch with a physician 314-362-2280.