Thyroid nodules

Thyroid nodules are growths or lumps in the thyroid gland in the front of your neck. This gland controls how your body uses energy. Most thyroid nodules are not cancer and do not cause problems. Many don’t even need treatment.

Sometimes a thyroid nodule can cause problems. Sometimes a nodule can make too much thyroid hormone. When a nodule makes too much hormone, the rest of the gland is suppressed and actually doesn’t work as hard as usual.

Most thyroid nodules are not cancerous. But if tests show cancer, surgery will be done to remove the nodule.

What causes thyroid nodules?
It is not clear what causes thyroid nodules. But people who have been exposed to radiation have a greater chance of getting them. Also, the nodules tend to run in families. So if your parents had thyroid nodules, you are more likely to have one.

What are the symptoms?
Most thyroid nodules are so small that you don’t even know you have one.

If you have a big nodule, you may be able to feel it, or you may notice swelling in your neck. It’s possible that you may also:

  • Feel pain in your throat or feel a lump in your throat.
  • Have a hard time swallowing.
  • Have trouble breathing.
  • Feel nervous, have a fast heartbeat, sweat a lot, or lose weight. These are symptoms of hyperthyroidism, where the thyroid gland makes too much thyroid hormone.
  • Feel tired or depressed, have memory problems, be constipated, have dry skin, or feel cold. These are symptoms of hypothyroidism, where the thyroid gland does not make enough thyroid hormone.

How are thyroid nodules diagnosed?
Most people don’t find thyroid nodules on their own, because the nodules aren’t easy to feel and don’t usually cause symptoms. Your doctor may have found a nodule on your thyroid when you were having a CT scan or ultrasound for another reason. Your doctor will do a physical exam and will ask you if you have symptoms or any changes in how you’ve been feeling.

You may have tests to see how well your thyroid is working and to make sure the nodule is not cancer. Possible tests include:

  • A blood test to check the level of thyroid hormone in your body and possible antibodies that your body produces against its own thyroid gland.
  • Thyroid ultrasound, to see the number and size of nodules or to locate the nodule for fine-needle aspiration.
  • Fine-needle aspiration to check the nodule for cancer. The small amount of material taken from the nodule is examined under a microscope for the presence of cancer cells. Three possible outcomes are possible, either the nodule is diagnosed as benign, malignant or inconclusive. If the sampling is inconclusive, you will have a discussion with your doctor about the next step be it surgery or further follow-up with an ultrasound to observe whether the nodule grows in size over time.
  • A thyroid scan, which uses radioactive material and a camera to see how well your thyroid gland is working. This is done if the level of thyroid hormone is high.

How are nodules in the thyroid treated?
If your nodule is not cancer (benign) and is not causing problems, your doctor will watch your nodule closely for any changes which may involve repeat ultrasounds. The good news is that ultrasound does not expose you to any harmful radiation and can be safely repeated many times. But if the nodule is large or causing problems with swallowing or breathing, you’ll need surgery to remove the nodule.

If your thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of radioactive iodine, which usually comes in a liquid that you swallow. Or your doctor may have you take medicine (antithyroid pills) to slow down the hormone production. In some cases, surgery may be done to remove an overactive thyroid nodule.

If your nodule is cancer (malignant), you’ll need surgery to remove the nodule. You may also need treatment with radioactive iodine to destroy any leftover cancer cells. After surgery, you may need to take thyroid medicine for the rest of your life.