by Mary J. Shomon
A thyroid nodule is a lump in the thyroid. The nodule can be a solid or liquid filled cyst or mass.
Sometimes, you’ll find a thyroid nodule yourself. You’ll notice some swelling, or feel a small lump in your neck, and have it checked by the doctor. Other times, you can’t feel or see a nodule, but it’s detected by your doctor during a physical exam, or on an x-ray, CT scan, MRI or ultrasound of the neck area.
While you might be concerned to learn you have a thyroid nodule, your first step is learning more about this common condition, and what it means for your health.
About Thyroid Nodules
Thyroid nodules are very common. Some experts estimate that most people will develop a thyroid nodule by the age of 50
Nodules can cause problems in four ways.
1. The nodule itself is producing excess thyroid hormone, making you hyperthyroid.
2. The nodule is impairing the thyroid, making it underactive, and making you hypothyroid.
3. The nodule is large, pressing on the windpipe, or impairing breathing and/or swallowing.
4. The nodule is cancerous.
Symptoms of nodules are wide-ranging. Some people have hyperthyroidism symptoms — such as palpitations, insomnia, weight loss, anxiety, diarrhea, and tremors — indicating that the nodule is producing too much thyroid hormone. Others may have hypothyroidism symptoms — weight gain, fatigue, depression — indicating that the nodule is making the thyroid underactive.
Some people cycle back and forth between hyperthyroid and hypothyroid symptoms, which can be confusing to both patient and doctor.
For others, the symptoms are more neck-specific, and may include difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness, choking or shortness of breath at night, or a feeling that food is getting stuck in your throat.
But the majority of people with thyroid nodules actually have no obvious symptoms that can be traced to the thyroid or nodules.
Any time people think about lumps or masses, there is the fear of cancer. But keep in mind: most nodules are benign, and only 5% are likely to be cancerous. Even among those nodules that are cancerous, thyroid cancer is considered one of the cancers with a favorable prognosis, and most forms are highly treatable and survivable. But you should always have a nodule evaluated by your physician as soon as you notice it.
Evaluating Thyroid Nodules
Typically, doctors will run a blood test to evaluate your thyroid hormone levels, and determine if the nodule is affecting thyroid hormone production. If you have any family history of medullary thyroid cancer, your doctor will also run calcitonin tests, which can help detect this less common form of thyroid cancer.
In addition to blood work, many practitioners do a thyroid scan that involves taking a small amount of radioactive iodine, and then having an x-ray to see what happens. Thyroid nodules may absorb the iodine ( these are called “warm nodules”), they may show dramatically increased uptake of the iodine (these are called “hot” nodules), or they take up little iodine and show decreased activity (these are called “cold” nodules). While warm and hot nodules are rarely cancerous, a small percentage of cold nodules may be cancerous. Cold nodules typically require further evaluation.
Most often doctors evaluate cold nodules by performing a “Fine Needle Aspiration,” (FNA) or a needle biopsy. In this procedure, a needle is inserted into the nodule to withdraw cells, which are then evaluated by a pathologist. Typically, findings will indicate that your nodule is:
Benign. This means your nodule is not cancerous. Approximately 70% of nodules will come back benign.
Malignant. This means your nodule is cancerous. Approximately 5 % of suspicious nodules will be malignant.
Suspicious. This means diagnosis wasn’t conclusive, but there was possible cancer.
Inconclusive. If the sampling wasn’t sufficient, a diagnosis might be difficult. In this case, an additional biopsy might be recommended.
Treatments for Thyroid Nodules
Typically, for a benign nodule, the treatment is to prescribe thyroid hormone, which may shrink the nodule, or prevent it from growing. If the nodule continues to grow, your doctor may biopsy it again, or recommend surgical removal.
If a benign nodules is toxic — it’s overproducing thyroid hormone — your doctor may recommend antithyroid drugs, radioactive iodine treatment, or in some cases, surgical removal of the nodule or even the thyroid gland.
If a benign nodule is causing your thyroid to be underactive, treatment is usually prescription thyroid hormone replacement medication, such as one of the levothyroxine drugs (Synthroid, Levoxyl, Levothroid), or a natural prescription thyroid drug like Armour Thyroid.
When a nodule is malignant or suspicious, doctors almost always surgically remove the nodule. While in surgery, the thyroid cells can be evaluated, and a decision to remove the lobe of the thyroid — or the entire gland — can be made based on the results. Based on the diagnosis, thyroid cancer treatment can then be pursued.
In the case of an inconclusive nodule, if a repeat biopsy is not possible, some doctors will recommend surgical removal and evaluation. The majority of these nodules are also benign.
Mary Shomon is an internationally-known thyroid patient advocate, and is author of a number of best-selling health books, including Living Well With Hypothyroidism and The Thyroid Diet. Since 1997, she has run the Internet’s most popular thyroid patient sites: About.com Thyroid Site and Thyroid-Info.com