Thyroid Nodules

Overview

Thyroid nodules affect up to seven percent of the U.S. adult population, occurring more often in women than men. They become more common as you age.

Symptoms

Most thyroid nodules do not produce symptoms. If you have one or more nodules, you might notice a lump in your neck. Physicians sometimes find thyroid nodules by chance during routine exams or while diagnosing and treating other conditions, such as carotid artery disease.

If a growth is large enough, you might experience problems such as:

• Hoarseness
• Difficulty swallowing
• Difficulty breathing
• Pain in the neck

Thyroid Nodules and Hyperthyroidism

Some thyroid nodules cause excess production of thyroid hormones, which play a role in many body functions, including regulation of body temperature and heart rate. Such nodules can produce symptoms of hyperthyroidism, such as fatigue, increased appetite and nervousness.

Thyroid Nodules and Hypothyroidism

Thyroid nodules can also result from Hashimoto's disease, an autoimmune disorder that often causes hypothyroidism. In such cases, you might experience symptoms of having too little thyroid hormone, such as weight gain, dry skin and intolerance to cold.

Diagnosis

IU Health physicians carefully evaluate all thyroid nodules to determine whether they represent a more serious condition. Fortunately, the vast majority of these nodules are not cancerous and do not present a serious threat to your health.

Thyroid nodules are assessed using a combination of clinical expertise and advanced technology. Diagnostic tools to evaluate thyroid nodules include:

Blood Tests

Several substances in your blood are checked, including:

• Thyroid-stimulating hormone (TSH)
• Thyroid hormones thyroxine (T4)
• Triiodothyronine (T3)

The results give a sense of your thyroid’s functioning and how any nodules might be affecting it.

Biopsy

A sample of your thyroid cells can be examined under a microscope for signs of cancer. This procedure is typically done using a hollow needle in a technique called fine needle aspiration (FNA) and takes less than half an hour. Numbing medicine is used to limit any discomfort you might feel.

In some cases, genetic testing is ordered on the tissue sample to help determine whether a nodule is cancerous or benign (noncancerous).

Ultrasound

In this imaging technique, high-frequency sound waves check various characteristics of thyroid nodules, including their size and location and whether they are solid or fluid-filled. During the procedure, a wand (transducer) moves over your thyroid area as you lie on your back with your neck stretched a bit. Ultrasound does not hurt. If your thyroid nodule does not need surgery right away, ultrasound can show changes over time. Ultrasound also helps guide the needle during a thyroid biopsy.

Thyroid Scan

This procedure evaluates the chance that a nodule is cancerous based on how well it absorbs a small amount of a radioactive substance, such as radioactive iodine. You take a small amount of radioactive iodine in a pill you swallow several hours before the procedure. The amount of radiation you receive is similar to that of a typical X-ray.

While you lie on a movable exam table, pictures of your thyroid are taken using a special device that detects radioactive objects. Scanning time is typically less than an hour. Nodules that take up the radioactive substance are called “hot” and are unlikely to be cancerous. Nodules that do not absorb the substance are called “cold” and may be either cancerous or noncancerous.

Treatment

Options for managing and treating your thyroid nodules may include:

Observation

If a thyroid nodule is small and shows no signs of cancer, and if you have no family history of endocrine cancers, then you might not need treatment. You will need to continue have the nodule checked for changes over the long term.

Radioactive Iodine

If you have a nodule that is producing too much thyroid hormone or you have a multinodular growth (multiple nodules), radioactive iodine may help shrink the growth. You typically take the medicine one time by mouth. The treatment is safe in general, but pregnant women should not take it because it may damage the developing fetus.

After you take radioactive iodine, you will receive guidelines to avoid exposing other people to radiation. For example, you should avoid close contact with family members and keep your toilet especially clean for several days until most of the medicine clears from your system. Radioactive iodine often causes the thyroid to become underactive (hypothyroidism), so you may need hormone replacement therapy after treatment.

Surgery

Surgery is recommended to remove any nodules that show signs of thyroid cancer. Surgical removal is also an option for noncancerous thyroid nodules if they cause problems with swallowing or breathing. Depending on your specific case, your surgeon may remove either all of the thyroid gland (total thyroidectomy) or only part of it (partial thyroidectomy).

You will receive general anesthesia for the procedure, which often takes two to four hours. The most common operation involves a cut a few inches long across the front of your neck. Lifelong hormone replacement therapy is necessary if your entire thyroid gland is removed.